Important information for medical practitioners

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This section provides articles and resources of great significance to medical practitioners seeing patients with ME/CFS.

Diagnosis

Resource: Curruthers, B & van de Sande, M (2005) Canadian ME/CFS Clinical Case Definition and Guidelines for Medical Practitioners (Overview), Carruthers and van de Sande, Canada.

This document includes:

How to make an accurate diagnosis (pg. 1-3);
Symptoms and effects upon the body (pg. 3-7);
Clinical evaluation for (pg. 7-9);
Symptom management and treatment (pg. 12-14);
Symptom severity check list (pg. 15);
Sleep and pain profile (pg. 16);
Assessing occupational disability (pg. 17);
Tests for abnormalities (pg. 18).

A full version of the document is also available:

Journal Article: Carruthers, B; Kumar Jain, A; De Meirleir, K; Peterson, D; Klimas, N; Lerner, M; Bested, A; Flor-Henry, P; Joshi, P; Powles, P; Sherkey, J; and van de Sande, M (2003) 'Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical case working definition, diagnostic and treatment guidelines, A consensus document', Journal of Chronic Fatigue Syndrome, vol. 11, no. 1, pp. 7 - 115, Haworth Medical Press Inc.

Journal Article: Jason, L (2006) 'A Paediatric Case Definition of ME/CFS', Journal of Chronic Fatigue Syndrome, vol. 13, no. 2/3.

POTS is a frequent finding in patients with ME/CFS. This research group suggests all clinical evaluation of patients with possible ME/CFS should include response to standing.

Why early diagnosis is important

ME Alliance UK, lead author Shepherd, C 'ME/CFS diagnosis: Delay harms health, Early diagnosis: Why is it so important?'.

"The earlier the diagnosis is made, the sooner supportive care from family, friends and health care professionals can be implemented including the use of pacing strategies, the greater the chance of a better outcome."

Complexities of diagnosis: Difference between ME and CFS

"Myalgic Encephalomyelitis (ME) is a clearly defined disease process. ME is an acute onset biphasic epidemic or endemic sporadic infectious disease process" (Hyde 2009, p. 77).

"CFS by definition has always been a syndrome" (Hyde 2009, p. 69).

Resource: Hyde, B (2009) 'Missed Diagnosis', Lulu.Com

Resource: Chapter 3, entitled 'Complexities of Diagnosis' by Byron Hyde in The Handbook of Chronic Fatigue Syndrome (2003) J, Leonard; P, Fennell; R Taylor, published by John Wiley and Sons Inc. You can download a copy here.

Both of these resources are available to borrow from the ME/CFS Australia (Victoria) library.

Differentiation between ME/CFS and depression and psychiatric conditions

Stein, E (2005) 'Clinical Guidelines for Psychiatrists: Assessment and Treatment of Patients with ME/CFS'.

Management Strategies

Pacing

Website: CFIDS & Fibromyalgia Self-Help by Bruce Campbell

Medications that may be of help

Journal Article: Stein, E (2009) Beyond tired: Helping patients cope with chronic fatigue syndrome, Pharmacy Practice, Dec/Jan 2009, pp. 14-21.

ME/CFS Disability Scale

It is useful for GPs and other medical practitioners to measure the level of activity and ability of patients with ME/CFS to function with a simple instrument on every visit - the ME/CFS (or CFIDS) Disability Scale. The ME/CFS Disability Scale assists in documenting improvements or otherwise in the condition and the effects of medications, as well as provding a useful marker for long-term changes. It may also serve as a key reference should you need to write a medical history or supporting letter for disability benefit claims.

In marking the score of patients on the scale, it is important to document as accurately as possible the severity of symptoms, the degree of activity impairment with both activity and rest, and the functional ability regarding full time work. The principle behind the ME/CFS Disability Scale is that the severity of symptoms is related to exertion - physical and mental.

The concept that severity of symptoms is related to exertion is not one necessarily understood by all doctors, Centrelink representatives, insurance companies and employers. As Dr. Bell remarks in his book, these people are more likely to subscribe to the understanding that 'when you are sick, you're sick', not 'when you work, you're sick'.

A copy of the scale is available on the website of the CFIDS Association of America, here.

Source: Adapted from Bell, D S (1994) 'The doctors guide to chronic fatigue syndrome: Understanding, treating and living with CFIDS', Addison-Wesley, USA. (Page 123).