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"What I wanted to say to everybody was, 'For God’s sake, help me! I feel as if I am dying.' But of course one doesn’t say those things. Stiff-upper-lip society."

— Toni Jeffreys
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Article Index

CME Online Courses on ME/CFS

A Case-Based Approach to Chronic Fatigue Syndrome, a new Continuing Medical Education (CME) course, was published by the Centers for Disease Control on April 19, 2013 and is available for CME credit until 4/19/2014. Health care providers make take this course for CME credit; others, including the public, are welcome to view the course without credit.

A Case-Based Approach to Chronic Fatigue Syndrome is intended for primary care providers, obstetrician/gynecologists, and pediatricians. Clinicians presenting this course are Lisa W. Corbin, MD; Anthony L. Komaroff, MD; Benjamin H. Natelson, MD; and Peter C. Rowe, MD.

The goal of this activity is to improve diagnosis and management of chronic fatigue syndrome (CFS).

Upon completion of this activity, participants will be able to:

  1. Introduce the 1994 International Case Definition to diagnose patients with CFS
  2. Outline the CFS symptom spectrum across different populations, including adults and adolescents
  3. Formulate a treatment plan that targets symptoms and manages medications
  4. Demonstrate ability to manage CFS on an individual basis through patient-case examples


Diagnosis and Management of Chronic Fatigue Syndrome
, a Continuing Medical Education (CME) course, was published by the Centers for Disease Control on June 27, 2012 and is available for CME credit until 6/27/2014. Health care providers make take this course for CME credit; others, including the public, are welcome to view the course without credit.

The Diagnosis and Management of Chronic Fatigue Syndrome course is intended for clinicians who desire a basic introduction to CFS diagnosis, and management.

After completing this course participants will be able to:

  1. Define CFS according to the 1994 Case Definition and discuss other definitions.
  2. Explain the diagnostic process for chronic fatigue syndrome.
  3. Discuss possible triggers, contributing factors, and physiology of CFS.
  4. Identify management strategies in CFS.
  5. Recognize the wide-ranging impact of CFS.

Learn more about the course.


Sleep Problems in Chronic Fatigue Syndrome (CFS)
, a Continuing Medical Education (CME) course, was published by the Centers for Disease Control on June 11, 2012 and is available for CME credit until 6/11/2014. Health care providers make take this course for CME credit; others, including the public, are welcome to view the course without credit.

Sleep Problems in Chronic Fatigue Syndrome (CFS) is intended for  clinicians who desire a basic introduction to CFS and sleep problem diagnosis and management.

After completing this course participants will be able to:

  1. Describe and review sleep problems affecting CFS patients.
  2. Explain the diagnostic process for characterizing sleep problems in CFS patients.
  3. Identify sleep management strategies in CFS.

Learn more about the course.


Chronic Fatigue Syndrome: The Challenges in Primary Care
, a new online Continuing Medical Education (CME) course, was published by Medscape and the Centers for Disease Control on March 23, 2012. This is a 30-minute video discussion by a panel of experienced clinicians who are experts in treating patients with ME/CFS: Anthony L. Komaroff, MD; Charles W. Lapp, MD; and Lucinda Bateman, MD.

This activity is intended for primary care providers who diagnose and/or manage patients with CFS.
The goal of this activity is to raise awareness about CFS and educate clinicians about diagnosing and managing CFS.

Upon completion of this activity, participants will be able to:

  1. Identify CFS utilizing the 1994 International Case Definition, and diagnose CFS using this definition and other clinical tools including physical and laboratory examinations
  2. Demonstrate the ability to treat and manage CFS on an individual basis
  3. Recognize the wide-ranging impact of CFS

Learn more about the course.

"The Latest Research on Chronic Fatigue Syndrome" – videocast of lecture by Dr. Anthony Komaroff, April 2010

ANTHONY KOMAROFF, M.D., Simcox-Clifford-Higby Professor of Medicine at Harvard Medical School and Editor-in Chief of Harvard Health Publications, presented a lecture, "The Latest Research on Chronic Fatigue Syndrome", to the Massachusetts CFIDS/ME and FM Association on April 24, 2010. We thank Dr. Komaroff for giving us permission to post his entire lecture on our website and greatly value his insights and updates on Chronic Fatigue Syndrome (CFS).  Dr. Komaroff is one of the preeminent pioneers in the research and treatment of CFS and tailored this lecture specifically to review research developments in CFS over the past decade.

We would like to encourage healthcare providers as well as their patients to take advantage of this informative presentation—it is suitable for both medical and lay audience. The lecture is a little under one hour long. It was professionally video-recorded and it includes a table of contents so that it can be viewed in shorter segments.

View the lecture

See more information and other options for accessing the lecture material.

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Clinical guides for diagnosis and treatment - 5 practical guides for ME/CFS and Fibromyalgia

These informative and concise clinical guides, based on the Canadian case definition, are suitable for both clinicians and patients and are highly recommended. These include guides for diagnosis, treatment and management of ME/CFS for adults, for children and adolescents, for psychiatric differential diagnosis and treatment in both adults and children/adolescents, and for Fibromyalgia. Read more.

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"What a primary care doctor can do for CFS patients" – recommendations by Dr. James Oleske, October 2010

Dr. James Oleske, a Professor of Pediatrics at the University of Medicine and Dentistry, Newark, New Jersey, in his talk of October 17, 2010 explained his theory of the multi-causality of Chronic Fatigue Syndrome (CFS) and also described some specifics for what a primary care doctor working with a CFS patient can and should do. These recommendations cover the initial evaluation, specialized studies, treatments, and the structure of an overall care plan, and may be helpful as a starting point for discussion and planning between patients and their physicians. He spoke at the New Jersey Chronic Fatigue Syndrome Fall Conference, October 17, 2010. Read the entire article.

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Coanalgesics for Chronic Pain Therapy:  A Narrative Review

Coanalgesics are medications that were not developed primarily for the treatment of pain, but have later been found to be effective for various types of intractable pain relief, either alone or in combination with other pharmaceuticals. This peer-reviewed paper gives a detailed survey of types of conanalgesics that exist, studies that show their effectiveness and suggested dosages.
Coanalgesics for Chronic Pain Therapy:  A Narrative Review, by Matthew J. Bair, MD, MS and Tamara R. Sanderson, BS

Recommended for persons with Chronic Fatigue Syndrome (or Fibromyalgia) who are anticipating surgery

Dr. Charles Lapp, a longstanding CFS/ME and FM clinician and Director of the Hunter-Hopkins Center in NC (which specializes in the evaluation and treatment of individuals with CFS/ME and FM) provides a list of recommendations for surgeons and anesthesiologists whose patients have CFS/ME and FM. Read these recommendations.

Articles by physicians for clinical management of CFIDS/CFS/ME – focus on key clinical aspects and research advances

Dr. Peter Rowe, at Johns Hopkins University School of Medicine, discusses Orthostatic Intolerance (OI), a central disabling symptom in a large percentage of patients with CFS/ME (information is available as video presentation and/or as PDF article). Plus concise summaries of clinical management and research updates by leading experts in the field. Review these articles.

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Canadian Expert Consensus Panel Clinical Case Definition for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

The Canadian Definition and Diagnostic protocols draw together the most rigorous findings both from the CFS-CDC sponsored research and the ME European research. As this definition was published partially under the auspices of the Canadian Ministry of Health, it is informally called the Canadian Definition.

The Canadian Definition does not rely on “prolonged fatigue” as the sole, principal (compulsory) criterion. More significance is given to post-exertional malaise and patients must become symptomatically ill after exercise and also have neurological, neurocognitive, neuroendocrine, dysautonomic, circulatory, and/or immune manifestations in order to meet the criteria. For these specific reasons, the Canadian Definition is regarded by many leading researchers and clinicians as the most medically accurate and detailed case definition for the Chronic Fatigue Syndrome/Chronic Fatigue and Immune Dysfunction Syndrome/Myalgic Encephalopathy/Myalgic Encephalomyelitis (CFS/CFIDS/ME).

The complete 109-page article "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols," was published in the Journal of Chronic Fatigue Syndrome, Vol. 11 (1) 2003, pp. 7-116. View the Canadian Definition in PDF format.

More information about the Canadian Definition and other clinical guidelines can be found at the Canadian Expert Consensus Panel Clinical Case Definition for ME/CFS website.

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Canadian vs new International Consensus Criteria

Proposed new criteria for diagnosing the illness Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), also known as Chronic Fatigue Syndrome (CFS), was published under the title, “Myalgic encephalomyelitis: International Consensus Criteria”, in the Journal of Internal Medicine, v. 270, n. 4, 295-400, Oct. 2011. “Myalgic encephalomyelitis (ME)” means muscle pain and inflammation of the brain and spinal cord. The article "Canadian vs Consensus Criteria" (in PDF format) reviews the basic features of the proposed 2011 diagnostic criteria and compares them with the 2003 criteria—the ME/CFS Canadian Case Definition.

 

Pediatric case definition for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

The pediatric diagnostic guidelines present recommendations developed by the International Association of Chronic Fatigue Syndrome Pediatric Case Definition Working group for a ME/CFS pediatric case definition. This group included the following national and international researchers and clinicians: Leonard A. Jason, PhD; Karen Jordan, PhD; Teruhisa Miike, MD; David S. Bell, MD, FAAP; Charles Lapp, MD; Susan Torres-Harding, PhD; Kathy Rowe, MD; Alan Gurwitt, MD; Kenny DeMeirleir, MD, PhD; and Elke L. S. Van Hoof, Clin Psych, PhD. Their purpose was to create a reliable instrument by which to assess ME/CFS in children and adolescents given the absence of a pediatric definition and diagnostic criteria.

“A Pediatric Case Definition for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome.” by Jason, Leonard A. et al, was published in the Journal of Chronic Fatigue Syndrome, Vol. 13, Issue 2/3, (2006), pp. 1-44.  View the Pediatric Case Definition in PDF format.

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Introductory CDC course material on Chronic Fatigue Syndrome: Diagnosis to Management

Several distinguished CFS/CFIDS/ME clinicians have teamed up with the CFIDS Association of America and Medscape to publish new educational materials for clinicians.

Chronic Fatigue Syndrome: Diagnosis to Management supplements the materials which are on the CDC site, which are several years old.

This information is suitable both for practicioners who have little experience with this illness, as well as those who may already have some knowledge about it. It may also be useful for patients who want to learn more about how the illness is diagnosed and current approaches to treatment.

In order to view the materials, you must register with Medscape if you have not already done so.  Registration is free, and anyone can register.

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Mitochondrial dysfunction, post-exertional malaise and CFS/ME

by Lucy Dechéne, Ph.D.

The goal of this article is to explain the role of mitochondrial function in CFS/ME because this tends to be overlooked or not well understood.  The article is germane to CFS/ME patients who have post-exertional malaise. This is a requirement for meeting the 2003 Canadian definition of CFS/ME and the majority of CFS/ME patients meeting the 1988 criteria have this symptom. Far fewer of those meeting the 1994 or other definitions will have this symptom. A patient who lacks post-exertional malaise does not have mitochondrial dysfunction. This type of exhaustion is unique to mitochondrial problems.  View the article.

The author of this article is an elected member of the New York Academy of Sciences, and Sigma Xi: The Scientific Research Honor Society, as well as other scientific societies. She is also a member of the board of the Massachusetts CFIDS/ME & FM Association.

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