special subjects
Chronic Fatigue Syndrome
Key Points
Chronic fatigue syndrome (CFS) is life-altering fatigue lasting > 6 months that typically affects previously healthy and active people; it is not malingering. Etiology is unclear but probably involves multiple factors, including genetic susceptibility, microbial exposure, and environmental and psychological factors. Diagnose CFS based on characteristic symptoms in patients with a normal examination and normal basic laboratory test results; Institute of Medicine (now the Health and Medicine Division of The National Academies of Science, Engineering, and Medicine) criteria may be helpful but are not strictly applied to individual patients. Validate patients' symptoms, encourage them to accept and accommodate to their disabilities, and perhaps try cognitive-behavioral therapy and/or graded exercise. Use medications as needed to treat specific symptoms (eg, pain, depression, insomnia). 