Chronic Fatigue-the definition problem
Vague definitions of "chronic fatigue syndrome" (CFS) make it impossible for physicians and psychologists to study it, any less diagnose it. A great NYT article summarizes this, and points out (as an example) that estimates of workers with carpal tunnel syndrome can range from 2.5% to 11% depending on whether the diagnoses required a physical exam, nerve testing, self-reported symptoms–or all three.
Although called it a syndrome, CFS is typically defined as: having disabling and unexplained fatigue of six month duration or more–basically a single symptom. This is called the 1991 Oxford criteria and largely overlaps with depression.
To better differentiate CFS, the C.D.C. offered a multi symptom definition of CFS in 1994 requiring at least four out of eight symptoms; i.e., muscle pain, joint pain, headaches, tender lymph noters, sore throat, cognitive problems, sleep disorders, and "malaise" after minimal exercise or activity. The C.D.C. then endorsed a clinically empirical (measurable) approach using screening questionnaires and cutoff scores to measure the symptoms more accurately. This helped little; e.g. one study reported that using this criteria 38% of CFS diagnosed patients really suffered only depression.
Canada, in 2003, offered more restrictive diagnostic criteria of CFS helping differentiate it from depression. DO MORE HERE
Now the race is on to find bacteria or viruses associated with CFS, which is being called myalgic encephalomyelitis. If specific proteins in spinal fluid can be found, an accurate test might be found. But, then how to distinguish it from other complex immune system disorders?
In many ways, the "need" for a diagnosis is driven by the need to find a way to get medical insurance to pay for treatment of a condition. The good news is since the treatments are essentially the same (exercise, counseling, medical care, etc.) the need for a specific diagnosis to drive treatment choices is relatively nil. Patients know if they are exhausted and/or in pain and come to doctors for help. A well rounded multi-option treatment program can be utilized with excellent effect. This is not a cookie-cutter program, as the specialist will choose different elements from their treatment option menu based on severity of individual symptoms. Yes, treating the symptoms (not a specific condition) is reasonable at this point until we can
A study in the Lancet (Mar, 2011:823-36) found cognitive behavior therapy (CBT) and graded exercise therapy (GET) to modestly assist medical care by a specialist in treating chronic fatigue, but found adaptive pacing therapy (APT) not helpful. Critics of this type of research argue that the vague definition of chronic fatigue syndrome
Vague definitions of "chronic fatigue syndrome" (CFS) make it impossible for physicians and psychologists to study it, any less diagnose it. A great NYT article summarizes this, and points out (as an example) that estimates of workers with carpal tunnel syndrome can range from 2.5% to 11% depending on whether the diagnoses required a physical exam, nerve testing, self-reported symptoms–or all three.
Although called it a syndrome, CFS is typically defined as: having disabling and unexplained fatigue of six month duration or more–basically a single symptom. This is called the 1991 Oxford criteria and largely overlaps with depression.
To better differentiate CFS, the C.D.C. offered a multi symptom definition of CFS in 1994 requiring at least four out of eight symptoms; i.e., muscle pain, joint pain, headaches, tender lymph noters, sore throat, cognitive problems, sleep disorders, and "malaise" after minimal exercise or activity. The C.D.C. then endorsed a clinically empirical (measurable) approach using screening questionnaires and cutoff scores to measure the symptoms more accurately. This helped little; e.g. one study reported that using this criteria 38% of CFS diagnosed patients really suffered only depression.
Canada, in 2003, offered more restrictive diagnostic criteria of CFS helping differentiate it from depression. DO MORE HERE
Now the race is on to find bacteria or viruses associated with CFS, which is being called myalgic encephalomyelitis. If specific proteins in spinal fluid can be found, an accurate test might be found. But, then how to distinguish it from other complex immune system disorders?
In many ways, the "need" for a diagnosis is driven by the need to find a way to get medical insurance to pay for treatment of a condition. The good news is since the treatments are essentially the same (exercise, counseling, medical care, etc.) the need for a specific diagnosis to drive treatment choices is relatively nil. Patients know if they are exhausted and/or in pain and come to doctors for help. A well rounded multi-option treatment program can be utilized with excellent effect. This is not a cookie-cutter program, as the specialist will choose different elements from their treatment option menu based on severity of individual symptoms. Yes, treating the symptoms (not a specific condition) is reasonable at this point until we can
A study in the Lancet (Mar, 2011:823-36) found cognitive behavior therapy (CBT) and graded exercise therapy (GET) to modestly assist medical care by a specialist in treating chronic fatigue, but found adaptive pacing therapy (APT) not helpful. Critics of this type of research argue that the vague definition of chronic fatigue syndrome