Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Diagnose ME/CFS when all three required features are present: a substantial reduction or impairment from pre-illness occupational, educational, social, or personal activity with new or definite-onset fatigue persisting for more than 6 months; post-exertional malaise (PEM); and unrefreshing sleep. Require at least one additional feature: cognitive impairment or orthostatic intolerance. The required symptoms and the additional qualifying symptom should occur at least half of the time with at least moderate intensity. CDC+1CDCIOM 2015 Diagnostic Criteria | ME/CFS | CDCCDC[PDF] What Is ME/CFS? | CDC

The history should establish a clear change from the patient's pre-illness function. Onset can be gradual or sudden and may follow an infectious-like illness or a documented infection such as infectious mononucleosis; a preceding infection supports but is not required for diagnosis. CDC+1CDC[PDF] What Is ME/CFS? | CDCPubMedRecommendations - Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - NCBI Bookshelf

Do not use the older label of chronic fatigue as a proxy for ME/CFS. Fatigue without PEM, unrefreshing sleep, and the required functional phenotype should prompt a broader diagnostic pathway rather than automatic assignment of ME/CFS. PEM is a defining discriminator, whereas post-exertional fatigue alone is not equivalent to PEM. BMJ+2BMJPost-exertional fatigue is not equivalent to post-exertional malaise | BMJ Paediatrics OpenCDCIOM 2015 Diagnostic Criteria | ME/CFS | CDCPubMedAccurate diagnosis of myalgic encephalomyelitis and chronic fatigue syndrome based upon objective test methods for characteristic symptoms - PMC

Ask the patient to describe the delay, duration, and symptom pattern after an activity that would previously have been tolerated. PEM is worsening after physical, mental, or emotional exertion; symptoms typically worsen 12 to 48 hours after the trigger and may persist for days or weeks. A same-day feeling of tiredness that resolves with usual rest is insufficient to establish PEM. CDC+1CDCIOM 2015 Diagnostic Criteria | ME/CFS | CDCcdn clinicaltrials[PDF] Abbreviated Title: - ClinicalTrials.gov

Clarify which domains flare after exertion: fatigue, cognitive dysfunction, pain, sleep disturbance, orthostatic symptoms, headache, nausea, or other baseline symptoms. The clinically useful feature is a delayed, prolonged, disproportionate multisymptom deterioration, often after minor exertion, rather than isolated post-activity muscle soreness. CDC+2CDCIOM 2015 Diagnostic Criteria | ME/CFS | CDCPubMedAccurate diagnosis of myalgic encephalomyelitis and chronic fatigue syndrome based upon objective test methods for characteristic symptoms - PMCcdn clinicaltrials[PDF] Abbreviated Title: - ClinicalTrials.gov

Use a prospective activity-and-symptom diary when the exertional relationship is unclear. Record physical, cognitive, and social demands alongside symptoms over subsequent days; this can identify individual activity limits and guide pacing. CDCCDCTreatment of ME/CFS in Children | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC

ME/CFS remains a clinical diagnosis. Obtain a detailed medical and social history, perform a comprehensive physical examination, and conduct a symptom-focused diagnostic workup to identify alternative disorders that could explain the presentation and comorbid conditions that require treatment. Do not require specialized objective tests to establish the diagnosis when the clinical criteria are met. CDC+1CDC[PDF] What Is ME/CFS? | CDCPubMedRecommendations - Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - NCBI Bookshelf

Build the differential around the dominant competing pattern. Sleep-related symptoms require assessment for sleep dysfunction; prominent mood symptoms require evaluation for depression, anxiety, and stress-related comorbidity; pain requires characterization and treatment as a coexisting symptom syndrome; and upright-provoked symptoms require focused orthostatic assessment. These conditions may coexist with ME/CFS and should not be used to dismiss a characteristic PEM history. PubMed+2PubMedChronic Conditions That Predominantly Impact or Affect Women Differently - Advancing Research on Chronic Conditions in Women - NCBI BookshelfCDCIOM 2015 Diagnostic Criteria | ME/CFS | CDCCDC[PDF] What Is ME/CFS? | CDC

For suspected orthostatic intolerance, measure heart rate and blood pressure after 10 minutes supine and during active standing at 1, 3, 5, and 10 minutes. This approach captures hemodynamic changes during upright posture and can support the symptom phenotype; interpret results with the clinical history rather than as a stand-alone ME/CFS diagnostic test. cdn clinicaltrialscdn clinicaltrials[PDF] A Platform Protocol for Evaluation of ... - ClinicalTrials.gov

Escalate beyond routine evaluation when the clinical course or examination suggests a separate organ-system disorder. New focal neurologic deficits, progressive cardiopulmonary limitation, syncope, inflammatory features, or other objective abnormalities warrant a disease-specific diagnostic pathway rather than attribution to ME/CFS alone. The purpose of the initial evaluation is to identify these competing or coexisting conditions while avoiding indefinite diagnostic delay. PubMedPubMedRecommendations - Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - NCBI Bookshelf

Initiate pacing, also called activity management or energy management, for patients with PEM. The operational goal is to balance activity and rest so that physical and cognitive demands remain within the patient's individual limits and do not repeatedly trigger PEM. Patients should plan activity and rest around those limits rather than pursue a predetermined progression. CDCCDCTreatment of ME/CFS in Children | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC

Use activity and symptom diaries early to define the patient's energy envelope. Review delayed symptoms after routine tasks, social activity, cognitive work, and upright time; then reduce or redistribute activities associated with flares. Limits differ between patients and may change over time, so plans should be individualized rather than based on a universal exercise target. CDCCDCTreatment of ME/CFS in Children | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC

Avoid an exercise plan that assumes fatigue is primarily deconditioning when PEM is present. A substantial proportion of patients with chronic fatigue syndrome in one treatment audit reported worsening with graded exercise, and PEM may occur despite pacing; therefore, any rehabilitative intervention should be symptom-titrated and reassessed for delayed deterioration. ScienceDirect+1ScienceDirectPacing and Exercise in Chronic Fatigue Syndrome - ScienceDirectNatureEffects of a symptom-titrated exercise program on fatigue and quality of life in people with post-COVID condition – a randomized controlled trial | Scientific Reports

There is no medication approved specifically for ME/CFS. Prioritize the symptom or comorbidity causing the greatest functional limitation, including sleep problems, pain, dizziness or lightheadedness, cognitive symptoms, and depression, stress, or anxiety. Discuss expected benefit and potential harm with the patient and revise the plan if an intervention worsens PEM or overall function. CDC+1CDC[PDF] What Is ME/CFS? | CDCCDCTreatment of ME/CFS in Children | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC

Long COVID definitions vary by organization, with symptoms persisting from 4 weeks to 3 months after acute infection; the World Health Organization definition requires symptoms lasting at least 2 months and extending beyond 3 months from onset without an alternative explanation. In a patient with persistent post-COVID symptoms, evaluate for the ME/CFS clinical phenotype rather than treating fatigue as a uniform syndrome. PubMedPubMedUpdated Clinical Practice Guidelines for the Diagnosis and Management of Long COVID

Patients with long COVID who have PEM may meet ME/CFS criteria. Apply the same core assessment: substantial functional impairment, PEM, unrefreshing sleep, and cognitive impairment or orthostatic intolerance. Approximately half of patients with long COVID have been reported to fulfill ME/CFS diagnostic criteria, although estimates vary by population and criteria used. cell+3cellUnravelling shared mechanisms: insights from recent ME/CFS research to illuminate long COVID pathologiesScienceDirectDiagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue SyndromePubMedPost-COVID Interstitial Lung Disease and Other Lung SequelaePubMedSelected Long-Term Health Effects Stemming from COVID-19 and Functional Implications - Long-Term Health Effects of COVID-19 - NCBI Bookshelf

When PEM is present after SARS-CoV-2 infection, use pacing and symptom-guided activity management as the initial safety framework. Do not equate an ability to complete an acute exercise session with absence of delayed or cumulative harm; evaluate symptoms in the 12- to 48-hour post-activity interval and over subsequent days. Nature+2NatureEffects of a symptom-titrated exercise program on fatigue and quality of life in people with post-COVID condition – a randomized controlled trial | Scientific ReportsCDCIOM 2015 Diagnostic Criteria | ME/CFS | CDCcdn clinicaltrials[PDF] Abbreviated Title: - ClinicalTrials.gov