NICE guidelines

The NICE guidelines for the diagnosis and management of chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy) were published in August 2007. They are used by the NHS and other medical professionals in the UK for diagnosing and treating ME/CFS.

Authors
The CFS/ME guideline development group consisted of the following members: Richard Baker, Jessica Bavinton, Esther Crawley, Tony Downes, Richard Eddleston, Ute Elliot, Richard Grünewald, William Hamilton, Judith Harding, Frederick Nye, Amanda O'Donovan, Alastair Santhouse, Julia Smedley, David Vickers, Gillian Walsh, Carol Wilson, Philip Wood, Gary Britton, Stefanie Kuntze, Elizabeth Shaw, Nancy Turnbull, and Tanya Harrison.

Definition
Healthcare professionals should consider the possibility of CFS/ME if a person has:


 * fatigue with all of the following features:
 * new or had a specific onset (that is, it is not lifelong)
 * persistent and/or recurrent
 * unexplained by other conditions
 * has resulted in a substantial reduction in activity level
 * characterised by post-exertional malaise and/or fatigue (typically delayed, for example by at least 24 hours, with slow recovery over several days)

and


 * one or more of the following symptoms:
 * difficulty with sleeping, such as insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep–wake cycle
 * muscle and/or joint pain that is multi-site and without evidence of inflammation
 * headaches
 * painful lymph nodes without pathological enlargement
 * sore throat
 * cognitive dysfunction, such as difficulty thinking, inability to concentrate, impairment of short-term memory, and difficulties with word-finding, planning/organising thoughts and information processing
 * physical or mental exertion makes symptoms worse
 * general malaise or ‘flu-like’ symptoms
 * dizziness and/or nausea
 * palpitations in the absence of identified cardiac pathology

Healthcare professionals should be aware that the symptoms of CFS/ME fluctuate in severity and may change in nature over time.

Signs and symptoms that can be caused by other serious conditions (‘red flags’) should not be attributed to CFS/ME without consideration of alternative diagnoses or comorbidities. In particular, the following features should be investigated:
 * localising/focal neurological signs
 * signs and symptoms of inflammatory arthritis or connective tissue disease
 * signs and symptoms of cardiorespiratory disease
 * significant weight loss
 * sleep apnoea
 * clinically significant lymphadenopathy

A diagnosis should be made after other possible diagnoses have been excluded and the symptoms have persisted for:
 * 4 months in an adult
 * 3 months in a child or young person; the diagnosis should be made or confirmed by a paediatrician

The diagnosis of CFS/ME should be reconsidered if none of the following key features are present:
 * post-exertional fatigue or malaise
 * cognitive difficulties
 * sleep disturbance
 * chronic pain