CFS/ME. Dr.R.Arulnanthy 03/08/09 BMJ 2007/Nice Guidance
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1 CFS/ME Dr.R.Arulnanthy 03/08/09 BMJ 2007/Nice Guidance
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3 CFS Anonymous
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5 FACTS Chronic fatigue syndrome is three times more prevalent in women than in men and is most common in younger adults, with 90% of cases in the year age range. difficult to diagnose because its symptoms can vary from person to person and because symptoms closely resemble those of various other disorders such as the flu or other viral infections, hypochondria, psychosomatic illness, depression, and mononucleosis. In fact, the symptoms of CFS so closely mirror those of fibromyalgia (with up to 70% of patients diagnosed with FM having signs and symptoms matching a diagnosis of CFS) that the only real difference between the two is that the main diagnostic criteria for FM is the requirement for musculoskeletal pain while the main criteria for CFS is disabling fatigue lasting for at least 6 months.
6 Key points NICE 2007 CFS is real and defined as an illness, disease process not understood Relatively common- 40/10,000 patients in a practice diagnosis is clinical by exclusion Mx-key part- acknowledge the reality and impact of the condition - working in partnership with patient
7 Diagnosis Clinical diagnosis. definite beginning. lasted 6 months (3months in children). Key symptoms disabling fatigue, mental fatigue. Exhaustion after light physical exertion. Muscle and joint pain sore throat mood swings depression sleep disorder. Exclusion of other physical and mental known causes.?autoimmune theory causes the problem
8 CFS more. Symptoms are 1) Unexplained, persistent, or relapsing fatigue that is not a result of ongoing exertion, is new (not lifelong), is not alleviated by rest, and results in a substantial reduction in previous levels of occupational, social, or personal activity The CDC's definition of Chronic Fatigue Syndrome (see above) is debated by many experts since it excludes or downplays many other symptoms (including many of the psychological symptoms) commonly manifested by those suffering from CFS. The chart below lists some of these symptoms as well as the rate at which they occur among CFS patients.
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10 2.) The occurrence of four or more of the following symptoms that have persisted or recurred for 6 or more consecutive months and that do not predate the fatigue: Substantial impairment in short-term memory or concentration Sore throat Tender lymph nodes Muscle pain Multi-joint pain without swelling or redness Headaches of a new type, pattern, or severity Unrefreshing and/or interrupted sleep Post-exertional malaise lasting more than 24 hours Sensitivity to odors, noise, bright lights, medications, and various foods
11 1.Symptoms- frequency order Fatigue 100% Low-grade fever 60-95% Muscle pain 20-95% Sleep disorder 15-90% Impaired mental function 50-85% Depression 70-85% Headache 35-85% Allergies 55-80% Sore throat 50-75% Anxiety 50-70% Muscle weakness 40-70% After-exercise fatigue 50-50%
12 2. Symptoms frequency order Premenstrual Syndrome (women) 50-60% Stiffness 50-60% Visual Blurring 50-60% Nausea 50-60% Dizziness 30-50% Joint pain 40-50% Dry eyes and mouth 30-40% Diarrhea 30-40% Cough 30-40% Decreased appetite 30-40% Night sweats 30-40% Painful lymph nodes 30-40%
13 How do I rule out other conditions?? Examination Neurological Inflammatory arthritis/ct disease Cardio respiratory Sleep apnoea Lymphadenopathy Investigation Urinalysis FBC/UE/LFT/TFT/CRP Creatinine. Calcium, CK, antiendomysial ab, random blood glucose
14 Chronic Fatigue Syndrome Self- management Program Sleep management Good sleep hygiene Discourage day time sleeping Rest periods Limit to 30mts period and review regularly Relaxation techniques into rest times Avoid prolonged rest periods
15 EXERCISE TRY REGULAR AND MODERATE EXERCISE: structured program of moderate and regular exercise Do not tell just to go to the gym
16 WATCH YOUR DIET: Eat a well-balanced diet that includes plenty of fruits, vegetables, whole grains and beans Consider low dose tricyclic for poor sleep or pain
17 Following have an evidence base CBT effectiveness Challenge the negative assumptions Graded exercise therapy Set base line exercise increase graduallyavoid boom and bust Activity mx Again base line set and gradual increment
18 Prognosis Better children than adults Children 54-94% 6 year improvement Adults 20-50% in medium term. Only 6% return to premorbid levels No increased mortality. Prognosis worse with psych disorder and belief about causation and treatment
4. A consensus definition of CFS/ME has been agreed by international experts for the purposes of research and includes the following:-
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STONEBURNER ACUPUNCTURE, LLC Erin K. Stoneburner, LAc, MAcOM 1135 SE Salmon St, Suite 211 503.784.1660 stoneburner@gmail.com Date: Name: (First) (Middle) (Last) DOB: _ Age: Sex: Address: City/State: ZIP:
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