Myalgic Encephalomyelitis or Chronic Fatigue Syndrome

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Sarah Carlisle & Jill Thompson from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description[edit | edit source]

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Prevalence[edit | edit source]

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Characteristics/Clinical Presentation[edit | edit source]

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Associated Co-morbidities[edit | edit source]

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Medications[edit | edit source]

While studies have investigated the use of various medications, none have been found to have consistent results. However, the following drugs are used to address and manage symptoms[1]:

  • Medications to reduce pain, discomfort, and fever
  • Medications to treat anxiety 
  • Medications to treat sleep disturbance (amitryptyline, nefazodone[2])
  • Medications to treat joint pain (amytryptyline[2])
  • Medications to treat depression (sertralin, paroxetine, nefazodone[2])
  • Anti-inflammatory drugs (aspirin, acetaminophen[2])
  • NSAIDS to address headache relief[2]
  • Deydroepiandrosterone (DHEA) was found in a pilot study to significantly reduce the pain, helplessness, anxiety, thinking, memory, and activities of daily living difficulties associated with CFS; however, further research is necessary[2].
  • Based on current evidence corticosteroids cannot be recommended for CFS due to complications of long-term use, Mineralcorticoids and Intravenous Immunoglobulin are not recommended either and need further research[2][3]

Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]

No specific tests that identify CFS have been found. One study reports that patients with CFS have demonstrated abnormal white blood cell count and brain MRI results[1]. Goodman suggests that physicians rule out other diagnoses (from list below: Differential Diagnosis) and make use of the CDC’s criteria to determine if an individual has CFS[4]. The CDC’s criteria are:

1. Clinically evaluated, unexplained persistent or relapsing chronic fatigue that is any of the following:

          a. New or definite onset

          b. Not the result of ongoing exertion

          c. Not substantially alleviated by rest

          d. Results in substantial reduction in previous levels of occupational, educational, social, or personal activities

2. The concurrent occurrence of 4 or more of the following symptoms:

          a. Substantial impairment in short-term memory or concentration

          b. Sore throat

          c. Tender lymph nodes

          d. Muscle pain

          e. Multiple arthralgias without swelling or redness

          f. Headaches of a new type, pattern, or severity

          g. Unrefreshing sleep

          h. Postexertional malaise lasting more than 24 hours

The symptoms must have persisted or recurred during 6 or more consecutive months of illness and must not have predated the fatigue[4].


Sixteen gene abnormalities have been found in individuals with CFS, some related to immunity and defense; however, further research is needed to determine just how gene expression might effect those with CFS[5].

Etiology/Causes[edit | edit source]

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Systemic Involvement[edit | edit source]

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Medical Management (current best evidence)[edit | edit source]

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Physical Therapy Management (current best evidence)[edit | edit source]

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Alternative/Holistic Management (current best evidence)[edit | edit source]

Cognitive Behavior Therapy (CBT) has been used to manage CFS, especially in reducing fatigue and decreasing pain[2][6][5]. CBT is a proactive approach on the patient’s part, involving self-reflection and monitoring in the hopes of discovering what kinds of behaviors or thoughts are causing the CFS symptoms[2]. CBT also involves learning coping strategies and initiating a daily schedule of rest and activity in order to address fatigue levels and optimize function[2].

Ayurveda[3], an Indian treatment dating back to 5000 BC, has been suggested to successfully treat individuals with CFS. Ayurveda utilizes several different techniques, ranging from detoxification therapies, herbs, oil treatments, to diet and lifestyle changes. The selection of particular treatments depends on the individual’s presentation.

Magnesium sulfate was shown in one randomized, double-blind, placebo-controlled study to have a positive affect on individuals with CFS[6].

Differential Diagnosis[edit | edit source]

The following are possible differential diagnoses[4]:

  • Fibromyalgia
            Patients usually demonstrate with increased pain, while patients with CFS experience greater fatigue. Some consider CFS and fibromyalgia to be one in the same; others believe CFS is an early form of fibromyalgia.[edit | edit source]
  • Mononucleosis
  • Lyme Disease
  • Thyroid conditions
  • Diabetes
  • MS
  • Various Cancers
  • Depression
  • Bipolar disorder
  • Myalgic encephalomyelitis[7]

Case Reports/ Case Studies[edit | edit source]

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Resources
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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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  1. ↑ 1.0 1.1 Teitel AD MD MBA, Zieve D MD MHA. Chronic fatigue syndrome. PubMed Health: A.D.A.M. Medical Encyclopedia. 2012. Available from: PubMed.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Gur, A., Oktayoglu, P. Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: new concepts in treatment. Current Pharmaceutical Design. 2008: 14;1274-1294. Available from: PubMed.
  3. ↑ 3.0 3.1 Vinjamury, S.P. MD, Singh, B.S. PhD. Ayurvedic Treatment of chronic fatigue syndrome-a case report. Alternative Therapies in Health and Medicine. Sept/Oct 2005: 11(5);76-78. Available from: PubMed.
  4. ↑ 4.0 4.1 4.2 Goodman CC., Fuller KS. Pathology: implications for the physical therapist. 3rd ed. St. Louis: Saunders; 2009.
  5. ↑ 5.0 5.1 Marshall, R BSc (HONS), Paul, L PhD, Wood, L PhD. The search for pain relief in people with chronic fatigue syndrome: a descriptive study. Physiotherapy Theory and Practice. 2011:27(5);373-383. Available from: PubMed.
  6. ↑ 6.0 6.1 Afari, N PhD, Buchwald, D MD. Chronic fatigue syndrome: a review. The American Journal of Psychiatry. 2003:160(2);221-236. Available from: PubMed.
  7. ↑ White PD, Goldsmith KA, Johnson AL, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomized trial. Lancet. 2011;377:823-836.
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