Myalgic Encephalomyelitis/Chronic Fatigue Syndrome:
Clinical Working Case Definition, Diagnostic and Treatment Protocols
BM Carruthers et al. Journal of Chronic Fatigue Syndrome Volume 11, Number 1, 2003
______________________________
LIST OF CONTENTS
ABSTRACT
7
INTRODUCTION
8
DIAGNOSTIC PROTOCOL
11
Clinical Working Case Definition
11
General Considerations in Applying the Clinical Case Definition to the Individual Patient
Discussion of Major Features of ME/CFS
Fatigue
Post Exertional Malaise and/or Fatigue
Sleep Dysfunction
Pain
Neurological/Cognitive Dysfunctions
Autonomic Manifestations
Neuroendocrine Manifestations
Immune Dysfunctions
Positive Diagnosis Using Suggestive Signs
13
14
14
15
16
16
17
18
19
20
21
Features of ME/CFS in Children
21
Clinical Evaluation of ME/CFS
22
Differences Between ME/CFS and FMS (Fibromyalgia Syndrome)
26
Differences Between ME/CFS and Psychiatric Disorders
Depression
Somatization Disorder
27
27
28
Assessing Prognosis
29
Assessing Occupational Disability
Requirements of the Occupational Disability Assessment
Assessing Symptoms of Person’s Disability
Assessing Rehabilitative Potential
Medical Documentation and Opinion
30
31
32
34
35
TREATMENT PROTOCOL
36
General Considerations
36
Page numbers locate the headings as they appear in the published journal article.
[Document 5]
Goal and Guidelines for Management/Treatment Programs
36
Individualizing Management Programs: Lifestyle Practices and Self-help Therapies
Patient Education
Self Development
Maximizing Sleep
Balanced Diet and Nutritional Considerations
Appropriate Body Movement and Fitness
39
39
41
41
42
42
Individualizing ME/CFS Exercise Programs
Initial Patient Evaluation
Optimize Medical Management Before Introducing an Exercise Program
Principles of Treatment
Write an Individualized Exercise Program in Conjunction with the Patient
Cautions Regarding Exercise/Rehabilitation Programs
43
44
44
44
45
46
Cognitive Behavior Therapy (CBT) and Graded Exercise Therapy (GET)
46
Treatment of Symptoms Causing Major Impairment and those Causing or
Aggravating Other Symptoms
49
Therapeutic Principles
Sleep Disturbance
Pain
Fatigue
Cognitive Dysfunctions
Dizziness/Orthostatic Intolerance
Irritable Bowel Syndrome
Anxiety States
Depression
Others (NADH, Magnesium, Simple Symptomatic Relief)
Treatment Directed to Possible Pathogenic Mechanisms
49
51
52
55
57
58
60
60
61
64
64
Immune Dysfunction
Central Nervous System/Autonomic Dysfunction
RESEARCH OVERVIEW
ME/CFS Symptoms: Description and Research Findings
Post Exertional Malaise and Fatigue
Sleep
Pain
Associated with Neuropathy
Neurocognitive Dysfunctions
Memory
Management of SensoryInformation
Autonomic Dysfunctions
65
67
68
68
68
69
70
70
71
72
73
73
Page numbers locate the headings as they appear in the published journal article.
[Document 5]
Cardiac/Circulatory Abnormalities and Neurally Mediated Hypotension (NMH)
Neuroendocrine Dysfunctions
Immune Dysfunctions
Antiviral Defense Pathway Dysregulation
Infectious Agents
Differences between ME/CFS and Depression
Future Research
73
76
76
77
78
79
80
AUTHORS’ NOTE
81
Consensus Panel
81
Consensus Coordinator
82
Acknowledgements
82
NOTES
83
REFERENCES
83
LIST OF APPENDICES
1. Glossary of Acronyms
98
99
2. ME/CFS Symptom Prevalence and Severity
101
3. Symptom Severity and Severity Hierarchy Worksheet
102
4. Signs and Symptoms
104
5. ME/CFS Clinical Diagnostic Worksheet
105
6. American College of Rheumatology 1990
Criteria for the Classification of Fibromyalgia
107
7. ME/CFS Patient Evaluation Worksheet
108
8. Protocol for Therapeutic Medication Trials
9. Poor Balance, NMH (Neurally Mediated Hypotension), POTS (Postural
Orthostatic Tachycardia Syndrome) and Vertigo
112
10. Karnofsky Performance Scale
114
11. Work Place Aggravators
115
12. Tests That May Be Used Inappropriately in the Assessment of ME/CFS
115
113
Page numbers locate the headings as they appear in the published journal article.
[Document 5]