Chronic Fatigue: Facts vs Fiction
References
Presentation given with IMO support on
12th June 2014 (Sydney) and
19th June 2014 (Melbourne)
Facilitated by Mr Steven Tipper
BAppSc(BiomedSc), MHA, FCHSM
Executive Director Clinical Services
Independent Medical Opinion
(IMO Pty Ltd)
1. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Clinical Case Definition and
Guidelines for Medical Practitioners. An Overview of the Canadian Consensus Document.
NOTES: Published 2005 This booklet is an Overview of Myalgic Encephalomyelitis/Chronic Fatigue
Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Guidelines. A Consensus
Document. Bruce M Carruthers, Anil Kumar Jain, Kenny L De Meirleir, Daniel L Peterson, Nancy G
Klimas, A Martin Lerner, Alison C Bested, Pierre Flor-Henry, Pradip Joshi, AC Peter Powles, Jeffrey A
Sherkey, Marjorie I van de Sande. Journal of Chronic Fatigue Syndrome 11(1):7-115, 2003. ISBN: 07890-227-9 © Haworth Medical Press Inc.
Source:http://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ve
d=0CDEQFjAB&url=http%3A%2F%2Fsacfs.asn.au%2Fdownload%2Fconsensus_overview_fms.pdf&
ei=QGV1U8e7CpCKuATm7oDwBQ&usg=AFQjCNEXqocY7H3fbMynBUCqOQaQzhLhQ&bvm=bv.66699033,d.c2E
NOTE: alternate 2003 publication Journal of Musculoskeletal Pain 11(4):3107, 2003. Co-published
simultaneously in “The Fibromyalgia Syndrome: A Clinical Case Definition for Practitioners”, pp. 3108,
2004. Editor: I. J. Russell http://sacfs.asn.au/download/consensus_overview_fms.pdf
2. Chronic Fatigue Syndrome (CFS) – Diagnosis. Centers for Disease Control and Prevention
http://www.cdc.gov/cfs/diagnosis/ Accessed 16/05/2014 10:55 AM AEST
3. Chronic Fatigue Syndrome (CFS) – The 1994 Case Definition.
http://www.cdc.gov/cfs/case-definition/1994.html
NOTES: The 1994 CFS case definition reflects the consensus viewpoint from many of the leading
CFS researchers and clinicians (including input from patient group representatives). Developed
primarily for research studies of CFS in adults it has also been used clinically. It was informed by
earlier case definitions and has been the definition most widely used since 1994. Recently additional
case definitions have been proposed, including one adapted for children and adolescents. These case
definitions share many features and differ in the emphasis given to specific symptoms and severity.
While information is being gathered on the usefulness of each of these case definitions, CDC uses the
1994 case definition as the basis for study and clinical education.
**THIS CASE DEFINITION SITE INFORMATION INCLUDES “Conditions that Exclude a Diagnosis of
CFS” and “Conditions that Do Not Exclude a Diagnosis of CFS”: refer REFERENCE SOURCE LINK**
4. Clinical Guides for ME/CFS and Fibromyalgia
These clinical guides are suitable for both clinicians and patients, and are highly recommended,
published online by Massachusetts CFIDS/ME & FM Association. https://www.masscfids.org/resourcelibrary/13-basic-information/321-clinical-guides-for-mecfs-and-fibromyalgia
5. Viral Cases summaries http://mecfslegal.110mb.com/index.php?p=2_15
Summary of the Whisprun case as outlined on the New South Wales ME/Chronic Fatigue Syndrome
Society website. NOTE: PLEASE REFER TO SEMINAR SLIDES 23-27 & ‘Whisprun’ HANDOUT
(latter prepared by Turks Legal for detailed briefing on the legal issues raised in this case)
6. Chronic fatigue syndrome (Supplement) Med J Aust 2002; 176 (9): 17-55.
Victoria Toulkidis, Produced by a Working Group convened under the auspices of the Royal
Australasian College of Physicians
NOTES: Definitive Clinical Practice Guidelines based on evidence up to publication in 2002, citing 528
references, produced by a Working Group of 14 expert clinicians under 2 Conveners from the Royal
Australian College of Physicians.https://www.mja.com.au/journal/2002/176/9/chronic-fatigue-syndrome
7. National Institute for Health and Care Excellence . Chronic fatigue syndrome/myalgic
encephalomyelitis (or encephalopathy): diagnosis and management of CFS/ME in adults
and children. NICE Clinical Guideline, issued August 2007.
http://publications.nice.org.uk/chronic-fatigue-syndromemyalgic-encephalomyelitis-orencephalopathy-cg53/guidance [Accessed 04 June 2014].
8. Statement of Principles concerning chronic fatigue syndrome. No. 11 of 2014 for the
purposes of the Veterans’ Entitlements Act 1986 and Military Rehabilitation and Compensation Act
2004. Australian Government – Repatriation Medical Authority
http://www.comlaw.gov.au/Details/F2014L00013
NOTE: Section 3 (a) provides a definition of “Chronic fatigue syndrome” as while 3 (b) defines the
detailed criteria for a diagnosis of chronic fatigue syndrome.
9. Fatigue after infection: aetiology and pathophysiology. Andrew R Lloyd. 4 September 2013
http://microbiology.publish.csiro.au/paper/MA13047.htm
NOTE: Article includes research details on causative viral agents & describes the evaluation of
post-infective fatigue through physical examination and laboratory investigations.
10. Exercise for chronic fatigue syndrome Australasian Cochrane Centre
Based on five included studies, this systematic review cautiously concludes that exercise therapy
is a promising treatment for chronic fatigue syndrome. However, studies of higher quality are
needed that involve different patient groups and settings
http://summaries.cochrane.org/CD003200/exercise-for-chronic-fatigue-syndrome
11. Cognitive behaviour therapy for chronic fatigue syndrome. Price JR, Mitchell E, Tidy E, Hunot
V Published Online: 15 April 2009. Australasian Cochrane Centre
This review aimed to find out whether CBT is effective for CBT, both as a standalone treatment
and in combination with other treatments, and whether it is more effective than other treatments
used for CFS. See more at: http://summaries.cochrane.org/CD001027/cognitive-behaviourtherapy-for-chronic-fatigue-syndrome#sthash.39zOPbtg.dpuf
Cognitive behaviour therapy for chronic fatigue syndrome
....- See more at: http://summaries.cochrane.org/CD001027/cognitive-behaviour-therapy-forchronic-fatigue-syndrome#sthash.QUpEB6Fa.dpuf
NOTES: See also: Cognitive Behavioral Therapy as Chronic Fatigue Syndrome Treatment
“It's hard to accept health-imposed changes to your life, and psychological counseling helps a lot
of people with these issues. Cognitive behavioral therapy (CBT) is aimed at modifying both
thoughts and actions to help you find healthier approaches to things and eliminate bad habits.
CBT is controversial because some doctors favor using it as a front-line therapy, while others
believe it's more appropriate as a complementary treatment.”
Source:http://chronicfatigue.about.com/od/treatingfmscfs/a/treating_CFS.htm
12. Traditional Chinese medicinal herbs for chronic fatigue Australasian Cochrane Centre
Treatment options for idiopathic chronic fatigue are limited. This review attempted to examine the
use of traditional Chinese herbal remedies for this condition. [Note no rigorous studies were found:
“Methodological limitations in the studies identified, such as type of control used and study design,
limited the usefulness of the data”] See more at:
http://summaries.cochrane.org/CD006348/traditional-chinese-medicinal-herbs-for-chronic-fatigue
13. Diagnostic and Statistical Manual of Mental Disorders (DSM-5): relevant articles
DSM5_Somatic Symptom Disorder Fact Sheet
http://www.dsm5.org/Documents/Somatic%20Symptom%20Disorder%20Fact%20Sheet.pdf
DSM5_changes from dsm-iv-tr to dsm-5
http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf
14. Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care
Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care Blog Feb 8, 2013
www.huffingtonpost.com/david-j-kupfer-md/dsm-5_b_2648990.html
15. Barsky AJ, Borus JF. Functional Somatic Syndromes. Ann Intern Med. 1999;130:910-921.
http://annals.org/article.aspx?articleid=712735 [Article summary online; subscribe for full article]
NOTE: This article was discussed in the Melbourne seminar led by Dr John Silver re:
somatization and the relationship of symptoms to presentations of proven CFS patients.
NOTE: A large number of studies have found ‘symptoms’ are a driver of healthcare use (e.g.,
http://bmjopen.bmj.com/content/4/6/e005374.full) but are also common in many illnesses of
normal life. Similarly, ‘medically unexplained conditions’ are a major societal burden (example:
Google Scholar found about 30,000 articles (in 0.05 sec) [Google Scholar LINK]. The particular
stressors in Chronic Fatigue Syndrome, and similar syndromes, are under scrutiny as ‘somatoform
disorders’ diagnosis and management improves (see for example Longing for existential
recognition: A qualitative study of everyday concerns for people with somatoform
disorders Journal of Psychosomatic Research. Volume 76, Issue 2 , Pages 99-104, February
2014 http://www.jpsychores.com/article/S0022-3999(13)00403-0/abstract and Childhood
stressors in the development of fatigue syndromes: a review of the past 20 years of
research Psychological Medicine Volume 44, Issue 09. July 2014, pp 1809-1823
Cambridge University Press 2013 DOI: http://dx.doi.org/10.1017/S0033291713002468
16. Ferrari R, Kwan O. The no-fault flavor of disability Syndromes Medical Hypotheses (2001)
56(1), 77–84 Harcourt Publishers Ltd doi: 10.1054/mehy.2000.1115, http://www.idealibrary.com
NOTE: This article was article discussed in Melbourne seminar led by Dr John Silver re:
somatization, “the sick role” and “secondary gains”.
QUOTE (p 81-82): “Somatization is the expression of psychological distress as bodily (physical)
symptoms (27). We have all somatized at some point (whenever experiencing a tension headache
at the end of a stressful day or a ‘nervous’ stomach before an anxiety provoking event).
Somatization is thus a part of daily life. Some, however, make somatization a way of life.”
SUMMARY: There are many controversial disability syndromes, representing medicolegal and
social dilemmas for a variety of medical disciplines. Health care professionals are at a loss to cure
these patients, and judges and disability review boards struggle to be fair while at the same time
trying to understand the basis and appropriateness of the evergrowing claims of disability. We
review these disability syndromes, examining the basis for their existence, their mechanism, and
how these patients can better be understood in a constructive and helpful manner. In doing so, we
emphasize the sick role, illness behavior, secondary and tertiary gain, and somatization.
The original article has been cited by others over > a decade, example topics via Scopus
links online: “View at Publisher” include Abstracts up to Full Articles are online & relevant !
http://www.scopus.com/results/citedbyresults.url?sort=plf-f&cite=2-s2.00035165645&src=s&imp=t&sid=2ECAB60A0EB3C290A819D8F21CD41344.N5T5nM1aaTEF8rE6
yKCR3A%3a30&sot=cite&sdt=a&sl=0&origin=inward&txGid=2ECAB60A0EB3C290A819D8F21C
D41344.N5T5nM1aaTEF8rE6yKCR3A%3a2
17. Medically Unexplained Physical Symptoms
NOTES: We engaged in both seminars (Sydney & Melbourne) in a spontaneous but brief
discussion of the role of General Practitioners in diagnosis and management of Chronic Fatigue
Syndrome & medically unexplained physical symptoms, particularly given their key role as
Nominated Treating Doctors in compensation claims cases.
A couple of articles illustrate the variety of research targeting the issue of causation (and possible
prevention) of such medically unexplained conditions:

Christopher Burton. Beyond somatisation: a review of the understanding and treatment
of medically unexplained physical symptoms (MUPS). Br J General Practice.March 1,
2003 vol. 53 no. 488 231-239 http://bjgp.org/content/53/488/231.short

Hedda Tschudi-Madsena (et. al.) Medically unexplained conditions considered by
patients in general practice Family Practice (2014) 31 (2):156-163. doi:
10.1093/fampra/cmt081 Published online: December 24, 2013 [Abstract:
http://fampra.oxfordjournals.org/content/31/2/156.abstract]
Thank you for taking the time & effort to read the research material above. Enquiries to:
IMO Pty Ltd Level 9, Suite 9-04, 175 Castlereagh Street Sydney NSW 2000
Office: 13 88 28 | Fax: 02 9267 5599 Email: info@imo.net.au or seminars@imo.net.au Web: www.imo.net.au
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