Chronic Fatigue Syndrome (CFS): a comprehensive approach to its definition & study. International CFS Study Group

The complexities of the chronic fatigue syndrome and the

methodologic problems associated with its study indicate the

need for a comprehensive, systematic, and integrated approach

to the evaluation, classification, and study of persons with

this condition and other fatiguing illnesses. We propose a

conceptual framework and a set of guidelines that provide such

an approach. Our guidelines include recommendations for the

clinical evaluation of fatigued persons, a revised case

definition of the chronic fatigue syndrome, and a strategy for

subgrouping fatigued persons in formal investigations.

MCM: Defines “fatigue” as “severe mental or physical

exhaustion, which differs from somnolence or lack of

motivation, and which is not attributable to exercise or

diagnosable d.”Prolonged fatigue lasts >1mo and “chronic

fatigue” is defined as present at least 6 mo.

“Chronic fatigue syndrome CFS” is diagnosed if severe

fatigue for >6mo, and four or more of these are present: (1)

impaired memory or concentration, (2) sore throat, (3) tender

cervical or axillary nodes, (4) muscle pain, (5) multi-joint

pain [w/o swelling], (6) new headaches, (7) unrefreshing

sleep, (9) post-exertion malaise.If 4 of the criteria are

not satisfied (and there is no other condition that would

“explain” CF (see below)), dx “idiopathic chronic fatigue

IFS”.Subgroup CFS and IFS by comorbid psych or other

conditions, current level of fatigue, duration of fatigue, and

level of physical function, w other subgrouping as desired.

Medical and psychiatric conditions that “explain” fatigue

(and exclude CFS/IFS) include (1) active & potentially

fatiguing medical conditions (e.g., untreated hypothyroidism,

sleep apnea, narcolepsy, medications), (2) previous medical

condition that may not have resolved (malignancies, Hep B or

C), (3) past or current dx of [severe] major depression w

psychotic or melancholic features, bipolar affective disorder,

schizophrenia, delusional disorder, dementias, anorexia

nervosa, and bulimia nervosa, or (4) alcohol or other

substance abuse within 2 years before the onset of CF and at

any time after.

Presents minimum lab and clinical assessment needed and

discourages further testing unless under protocol.

Want to wait before changing name of the S until better


The CFS study group consists of: Schluederberg A, Jones

JF, Lloyd AR, Wessely S, Gantz NM, Holmes GP, Buchwald D,

Abbey S, Rest J, Levy JA, Jolson H, Peterson DL, Vercoulen

JHMM, Tirelli U, Evengard B, Natelson BH, Steele L, Reyes M,

Reeves WC.

Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A

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