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Recommendations by James Oleske, M.D., M.P.H.

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.

Dr. Oleske emphasized that even if a physician has not had much experience evaluating and treating CFS patients, there is still much that s/he can do for the patient.


Initial evaluation of the patient


Further evaluation

Further evaluation should include:


Treatment plan

A treatment plan for CFS must first address treating the symptoms to improve the patient's quality of life.

Symptoms which can often be well-managed by standard approaches include:

Specific investigational therapies (if available) may include:

Finally, it is important to structure a Long-term Care Plan, based on a chronic illness model of care. Important items to include are:


What is health-related quality of life?

Dr. Oleske asks physicians to consider "What is health-related quality of life?" He said it recognizes the multi-dimensional nature of health and brings together physical, psychological and social domains that influence health status. It reflects a transition from measuring mortality to understanding morbidity, but there is no one accepted definition. Quality of life domains include:

Special issues in assessing quality of life in children include the following

Why is assessing quality of life important?

When multiple treatment regimens are available, quality of life assessment may be a factor in treatment choice. Understanding the relationships among disease, symptoms, treatments, and social factors is critical to providing optimum care.

Dr. Oleske closed his talk with a quote from Aesop: "No act of kindness, no matter how small, is ever wasted."


More Resources

For further information about diagnosis, see the 2003 Canadian Definition, Pediatric Case Definition, as well as the Differential Diagnoses articles.

For more information about ME/CFS symptoms and their frequency, see the list compiled by Paul Cheney MD (the Cheney Clinic, specializing in ME/CFS), Anthony Komaroff MD (the Harvard Medical School), Charles Lapp MD (Hunter-Hopkins Center, specializing in ME/CFS)) and Daniel Peterson MD (Whittemore-Peterson Institute for Neuro-Immune Disease), by clicking on the Symptoms Checklist.

For comments on the confusion concerning the role of psychological conditions in ME/CFS, see the article by psychiatrist Alan Gurwitt MD, "On the Morbid Fascination with Psychiatric Morbidity" and a summary of an article by Anthony Komaroff MD in The American Journal of Medicine, "Differences between CFS and Major Depression."

Other articles in the Differential Diagnoses section address differentiating between ME/CFS and various specific psychological conditions, such as depression.