COMMENTARY

Chronic Fatigue Syndrome: Right Name, Real Treatments

Peter D. White, MD

Disclosures

March 12, 2015

In This Article

Why the New Name Misses the Mark

Since the Medscape article was published, an important report has been published by the Institute of Medicine which describes new clinical diagnostic criteria and recommends a new name for the illness.[2] The new diagnostic criteria may help clinicians to make a diagnosis by concentrating on core symptoms of disabling fatigue, postexertional malaise, and unrefreshing sleep, but these new criteria will need empirical validation. The report drops a previous recommendation to undertake a mental state examination, vital in assessing alternative or comorbid mental health problems, but includes cognitive impairment and/or orthostatic intolerance as diagnostic criteria; some would question whether orthostatic intolerance is a key feature. The report does not sufficiently clarify whether the presence of such diagnoses as sleep or mood disorders are alternative diagnoses or allowable comorbid conditions.[22]

I would suggest that the new proposed name of SEID may be less helpful. Systemic implies that the condition affects many body systems, but even the most replicated abnormality, of a downregulated hypothalamic-pituitary adrenal axis, only affects a minority of patients and is probably a secondary phenomenon.[23] The report itself suggests that other replicated findings in other systems, such as reduced natural killer cell activity, are nonspecific.[2]Exertion intolerance is consistent with a characteristic feature of the condition, but another characteristic feature is that the fatigue is not relieved by rest,[2,7,24] so the illness is more than just being ill after exertion. Disease implies that there is an established pathology, but the report itself again suggests that no pathology has been properly identified. A more convincing name or names for the condition will come from a better understanding of its pathophysiology, which itself will come from studying the heterogeneous subgroups that many researchers and clinicians already accept as the reality of this condition.[25]The definition of a syndrome defined by chronic fatigue, CFS, is consistent with our current understanding.[24,26]

In the meantime, clinicians may be reassured that two treatments are moderately effective, safe, and cost-effective, and that patients can be given substantial hope of improvement—and sometimes recovery.[27]

*Professor Trudie Chalder, Kings College London, and Michael Sharpe, University of Oxford, were co-principal investigators of the PACE trial. The views expressed above are my own.

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