Key learning
- > 4 months debilitating fatigue
- Affects physical and mental function and present > 50% of the time
- Affects all ages, more common young females
- Normal physical examination
- Exclude other causes of tiredness (TATT screen)
- Manage symptoms and improve quality of life- CBT, graded exercise, pacing strategies
Pathophysiology
- Complex and poorly understood; involves dysregulation of the immune, neuroendocrine, and autonomic nervous systems, leading to persistent fatigue and other symptoms.
Epidemiology
- Prevalence 1%
- Affects all age groups
- More common in females
- Peak onset in early adulthood
History
Severe, persistent, debilitating fatigue
- > 4 months
- Affects both mental and physical function
- Present > 50% of the time
- Not relieved by rest
- Significantly impacting daily functioning
- Often worsen after physical or mental exertion (post-exertional malaise)
- May be accompanied by cognitive difficulties (brain fog), unrefreshing sleep, muscle and joint pain, and headaches.
Investigations/Examination
- Normal physical examination
- No organic cause identified on blood tests etc.
- Diagnosis is clinical
Management
Aim is to control symptoms and improving quality of life
- Cognitive-behavioural therapy - evidence based efficacy
- Pacing strategies (organise activities to avoid tiring)
- Graded exercise therapy
- Consider low dose amitriptyline for poor sleep
- Consider pain management clinic if pain pre-dominates