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[[File:WHO.JPG|200px|thumb|right|WHO Logo]] [[File:WHO Flag 1.png|450px|thumb|right|WHO Flag]] The World Health Organization (WHO) "directs and coordinates" international health within the United Nations. It was established on 7th April 1948, and is headquartered in Geneva, [[Switzerland]]. The WHO works with 194 member states across the world.<ref>{{Cite web|url=http://www.who.int/about-us | title = About Us | last = World Health Organization | first= | date = |website=World Health Organization|language=en-US|archive-url=|archive-date=|url-status=|access-date=2018-10-14}}</ref> The '''International Statistical Classification of Diseases and Related Health Problems''' (ICD) is the "the bedrock for health statistics" and is maintained by WHO. It aims to classify every possible injury or disease a person may experience, including causes of death.<ref>{{Cite web|url=http://www.who.int/health-topics/international-classification-of-diseases | title = International Classification of Diseases | last =World Health Organization | first= | date = |website=World Health Organization|language=en-US|archive-url=|archive-date=|url-status=|access-date=2018-10-14}}</ref> ==<span id="icd8">First recognition of ME/CFS</span >== [[Myalgic encephalomyelitis]] (ME) has been recognized by the World Health Organization as a [[Nervous system|neurological]] disease since 1969, when it published the '''ICD-8''' classification of diseases using code 323 for myalgic encephalomyelitis.<ref name="ICD-8">{{Cite book | url =https://apps.who.int/iris/bitstream/handle/10665/70934/ICD_10_1969_eng_v2a.pdf | title = Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death Based on the Recommendations of the Eighth Revision Conference | last =World Health Organization | first=|publisher=WHO| year = 1969|isbn=|editor-link=|edition=Eighth|volume=2|location=Geneva | page = 173|chapter=|quote=Encephalomyelitis (chronic),<br>(myalgic, benign) 323|editor-last2=|editor-link2=}}</ref><ref name=ICD-8-conf>{{Citation|url=https://apps.who.int/iris/bitstream/handle/10665/137300/WHA19_PB-6_eng.pdf?sequence=1&isAllowed=y | title = Report of the International Conference for the Eighth Revision of the International Classification of Diseases | last =World Health Assembly, 19 |publisher =World Health Organization | first=| year = 1966|chapter=DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS | page = 42}}</ref> The ICD-8 listing for [[ME/CFS]] is: *VI. DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS :Inflamatory diseases of central nervous system (320-324) ::Encephalitis, myelitis, and encephalomyelitis (except acute infectious As 343) :::'''Encephalomyelitis''' (chronic) (disseminated, acute) (granulomatous) ::::(hemarrhagic necrotizing. acute) ::::('''myalgic, benign''') ::::(postexanthematous) ::::(postinfectious) (see also Encephalitis) 343) The [[United States]] edition of the ICD-8 included both myalgic encephalomyelitis (ME) and what is now known as [[postviral fatigue syndrome]] (PVFS), classifying both with code 323:<ref name=ICD-8-US>{{Cite book | title=International Classification of Diseases, Adapted for Use in the United States, ICDA|volume = 2| page = 178|edition =8 | date = 1969 | url = https://books.google.co.uk/books?id=ZkbRSmyK0h8C&newbks=0&dq=International%20Classification%20of%20Diseases%20eighth%20%20-coding%20%20%22benign%20%22%20%22Myalgic%20%22%20%22encephalomyelitis%20%22&pg=PA178#v=onepage&q&f=false|publisher =World Health Organization|location=Geneva}}</ref > *'''Encephalomyelitis''' (chronic) (disseminated, acute) (Branulomalous) ::(hemorrhagic necrotizing, acute) ::('''myalgic, benign''') ::(postexanthematous) ::(postinfectious) (see also Encephalitis). The ICD-8 did not include any alternative names for myalgic encephalomyelitis although postinfectious encephalomyelitis could be classified under the same code; fatigue-related alternative names were not added in any later revisions.<ref name="ICD-8" /><ref name="icd10-2016" /> The alternative name [[chronic fatigue syndrome]] (CFS) was not in use at this time; it was proposed in 1988 by the [[Centers for Disease Control]], which adopted [[Holmes criteria|new diagnostic criteria]] at the same time.{{Citation needed| date = February 19, 2021}} The current version of the ICD is the '''[[#icd10|ICD-10]]'''; the newer '''[[#icd11|ICD-11]]''' has been published but is expected to be in widespread use within the next few years. ==<span id="icd9">ICD-9 classification of ME/CFS</span >== In the ICD-9, which was published in 1989, the entry for myalglc encephalomyelitis is uses code 323.9:<ref name="ICD-9">{{Cite book | url =https://apps.who.int/iris/bitstream/handle/10665/40492/9241540052_eng_v2_p1.pdf?sequence=3&isAllowed=y| title = Manual of the international statistical classification of diseases, injuries, and causes of death : based on the recommendations of the ninth revision conference, 1975, and adopted by the Twenty-ninth World Health Assembly, 1975 revision: alphabetic index | first = | last = World Health Organization & International Conference for the Ninth Revision of the International Classification of Diseases|publisher=World Health Organization | year = 1978|isbn=9241540044|editor-link=|edition=Ninth|volume=2|location=Geneva | page = 182|chapter=|quote=}}</ref> *DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS :'''Encephalomyelitis''' (chronic) (granulomatous) (hemorrhagic necrotizing, acute) '''(myalgic, benign''') (see also Encephalitis) 323.9 :- acute disseminated (postinfectious) 136.9 323.6* :- - postimmunization 323.5 :— due to or resulting from vaccination (any) 323.5 :- postchickenpox 052 323.6* :- postmeasles 055.0 323.6* :- postvaccinal 323.5 :- rubella 056.0 323.4* ==<span id="icd10">ICD-10 classification of ME/CFS</span >== {{bookmark|ICD-10}} The '''ICD-10''' lists [[myalgic encephalomyelitis]], [[chronic fatigue syndrome]], and [[Postviral fatigue syndrome|postviral syndrome]] (PVFS) as the same neurological disease, within the neurological disorders section.<ref name="gibson2012">{{Cite web|url=http://www.erythos.com/gibsonenquiry/docs/me_inquiry_report.pdf | title = Inquiry into the status of CFS / M.E. and research into causes and treatment (The Gibson Report) | last =Group on Scientific Research into Myalgic Encephalomyelitis | first = | date = Nov 2006 | website = |format = PDF | archive-url=|archive-date=|url-status=|access-date=2018-10-14|quote=Andre L’Hours of the WHO Head Office confirmed this definition formally in writing in 2001 and again in 2004 to Lord Warner. The Group was concerned to find that there is no mention of this classification in the Chief Medical Officers Report 2002 or in the current NICE guidelines. CFS is currently not present under any code in the ICD-10 on the WHO website current Tabular version. However, it is in the current Index version, according to the WHO North American Collaborating Center representative, who stated via email in September 2006 that "Chronic fatigue syndrome is indexed in the following manner in ICD-10:<br >Syndrome- fatigue F48.0- - <br >- chronic G93.3- -<br > - postviral G93.3" 8<br >The ICD-10 categorises Lethargy and Tiredness under section R “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” specifically under R53 ‘Chronic Malaise and Fatigue’. It specifically excludes ME and PVS (G93.3) and fatigue syndrome (48.0) from this definition.<br >The ICD-10 lists Fatigue syndromes under Section F48.0 Neurasthenia, but this section explicitly excludes ME and PVS (G93.3) or Malaise and Fatigue (R53).The WHO in Geneva holds an internationally recognised classification that ME is a neurological disease.}}</ref> *Diseases of the nervous system ::Other disorders of brain :::Other disorders of the nervous system ::::'''G93.3 Postviral fatigue syndrome''' ::::Benign [[myalgic encephalomyelitis]]<ref name="icd10-2016">{{Cite web|url=https://icd.who.int/browse10/2016/en#/G93 | title = G93 Other diseases of the nervous system|work =ICD-10 Version:2016 | last =World Health Organization | first= | authorlink = | date = 2016 | archive-url=|archive-date=|url-status=|access-date=2019-04-13}}</ref> [[Myalgic encephalomyelitis]] (ME) has been classified by the WHO as a [[neurological disorder|neurological disease]] since 1969<ref name="ICD-8" /> and has occurred in both [[Epidemic myalgic encephalomyelitis|epidemic]] and sporadic form since at least the 1930s, although is probably much older. ===Malaise and fatigue=== The World Health Organization has stated that ME and CFS can only be classed as a neurological disorder and ''cannot'' be classified under the following "malaise and fatigue" diagnosis (in the General signs, symptoms and abnormal findings), or as [[neurasthenia]] or Fatigue syndrome in the [[:Category:Mental disorders |mental and behavioral disorders category]]: '''R53.83 Malaise and fatigue''' categorizies "lethargy" and "tiredness" which are regarded as "Signs, symptoms and abnormal findings" rather than a specific disease. '''F48.0 Neurasthenia''' This is classed as a neurotic (anxiety) disorder, within the [[:Category:Mental disorders |mental disorders]] section of the ICD-10; it is describes this as "increased fatigue" which may be after mental effort, or emphasizing "feelings of bodily or physical weakness and exhaustion after only minimal effort", with an inability to relax and "a feeling of muscular aches and pains". In the ICD-10 this excludes burn-out (Z73.0), malaise and fatigue (R53) and postviral fatigue syndrome (G93.3).<ref name="NeurastheniaICD10">{{Cite web|url=https://icd.who.int/browse10/2016/en#/F48.0 | title = F48.0 Neurasthenia - ICD-10 Version:2016 | last =World Health Organization | first= | authorlink = World Health Organization|website=World Health Organization|archive-url=|archive-date=|url-status=|access-date=2019-04-13}}</ref><ref name="gibson2012" /><br> Chronic fatigue with no known cause which does not meet the criteria for [[chronic fatigue syndrome]] is referred to as either [[idiopathic chronic fatigue]] or a [[medically unexplained symptoms|medically unexplained symptom]] in medical literature. ==<span id="icd-10-cm">ICD-10 coding manual</span>== {{bookmark|ICD-10-CM}} The '''ICD-10-CM''' used in the [[United States]] is a coding manual used for insurance purposes, differs from other countries, and includes two different classifications, each with virtually identical symptoms: * R53.82 [[Chronic fatigue syndrome|Chronic fatigue, unspecified]], which is given the alternative name Chronic Fatigue Syndrome and classified "not otherwise specified", and excludes Myalgic Encephalomyelitis and Chronic Fatigue Syndrome (and anything that can be classified as G93.3),<ref name=":1" /><ref name="gibson2012" /> * [[Postviral fatigue syndrome|G93.3 Postviral Fatigue Syndrome]], alternatively known as Benign Myalgic Encephalomyelitis or Chronic Fatigue Syndrome.<ref name="icd11" /> ICD 9 (and 10) "consider NOS the physician's fault: The documentation does not provide enough information to assign a more specific diagnosis code."<ref>[https://www.supercoder.com/coding-newsletters/my-radiology-coding-alert/reader-question-nec-nos-there-are-differences-article Reader Question: NEC, NOS: There Are Differences - Radiology Coding Alert - SuperCoder]</ref> ==<span id="icd11">ICD-11</span >== {{bookmark|ICD-11}} In the more recently released '''ICD-11''', [[Postviral fatigue syndrome|Postviral fatigue syndrome]] (PVFS) is the name used for benign myalgic encephalomyelitis and chronic fatigue syndrome, and remains a disorder of the [[nervous system]].<ref name="icd11">{{Cite web|url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/569175314 | title = Postviral fatigue syndrome|work= ICD-11 - Mortality and Morbidity Statistics | last =World Health Organization | first= | author-link = | date = |language=en|archive-url=|archive-date=|url-status=|access-date=2018-10-14}}</ref> 08 Diseases of the nervous system :Other disorders of the nervous system ::'''8E49 Postviral fatigue syndrome''' ::Benign myalgic encephalomyelitis ::chronic fatigue syndrome<ref name="icd11" /> == ICD Diagnostic coding == '''ICD-10''' is the 10th revision of the ICD and was first published in 1992.<ref name="Barr2016">{{Cite journal | last =Manchikanti | first = L. | last2 = Chittle | first2 = M. D. | last3 = Barr | first3=R.M. | last4 = Liu | first4 = R.W. | last5 = McGinty | first5 = G. | last6 = Nicola | first6 = G. | last7 = Hirsch | first7 = J.A. | date = 2016-04-01 | title = ICD-10: History and Context|url=http://www.ajnr.org/content/37/4/596|journal=American Journal of Neuroradiology|language=en|volume=37|issue=4|pages=596–599|doi=10.3174/ajnr.A4696|issn=0195-6108|pmid=26822730}}</ref> The ICD-11 was published in July 2018, but is not implemented in most countries at present.<ref name="icd11" /> Different countries' government healthcare systems might use different codes depending on their interpretation of some diseases, illnesses, and syndromes but still working within the ICD code structure. When using [https://www.icd10data.com/ ICD10Data.com], certain pages will display a country's flag indicating the diagnostic coding used by that nation's healthcare system.<ref>[https://www.icd10data.com/ICD10CM/Codes/R00-R99/R50-R69/R53-/R53.82 Chronic Fatigue Syndrome - ICD10data.com]</ref> Additionally, a country does not have to officially implement the latest ICD release; the [[United States]] delayed the implementation of ICD-10 for over 20 years before implementing it's own WHO-approved adaption, the ICD-10-CM.<ref>[https://www.webpt.com/blog/post/history-icd-10 The History of ICD10 - WebPT]</ref><ref name="Manchikanti2015">{{Cite journal | last =Manchikanti | first = Laxmaiah | last2 = Kaye | first2 = Alan D. | last3 = Singh | first3 = Vijay | last4 = Boswell | first4 = Mark V. | date = Jul 2015 | title = The Tragedy of the Implementation of ICD-10-CM as ICD-10: Is the Cart Before the Horse or Is There a Tragic Paradox of Misinformation and Ignorance?|url=https://www.ncbi.nlm.nih.gov/pubmed/26218946/|journal=Pain Physician|volume=18|issue=4| pages = E485–495|issn=2150-1149|pmid=26218946}}</ref><ref name="bigpicture">{{Cite web|url=https://contemporaryclinic.pharmacytimes.com/news-views/appreciating-the-big-picture-of-icd-10 | title = Appreciating the Big Picture of ICD-10 | website = contemporaryclinic.pharmacytimes.com|access-date=2019-04-13}}</ref> ===Myalgic encephalomyelitis=== ==== ICD-10-CM ==== '''United States''' *'''G93.3''' [[Postviral fatigue syndrome]] and benign [[myalgic encephalomyelitis]].<ref name="icd11" /><ref>[https://www.icd10data.com/ICD10CM/Index/E/Encephalomyelitis Encephalomyelitis - ICD10 Data.com]</ref> '''ICD-10-CM G93.3 is grouped within Diagnostic Related Group(s) (MS-DRG v35.0):''' :*947 Signs and symptoms with mcc :*948 Signs and symptoms without mcc Convert G93.3 to ICD-9-CM Code History :*2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM) :*2017 (effective 10/1/2016): No change :*2018 (effective 10/1/2017): No change Code annotations containing back-references to G93.3: :*Type 1 Excludes: A85, R53.82 :*Type 2 Excludes: G04 Diagnosis Index entries containing back-references to G93.3: :*Akureyri's disease G93.3 :*Disease, diseased - see also Syndrome :::Iceland G93.3 :*Encephalomyelitis G04.90 - see also Encephalitis :::[https://www.icd10data.com/ICD10CM/Codes/G00-G99/G89-G99/G93-/G93.3 '''benign myalgic G93.3'''] :::myalgic, benign G93.3 :*Neuromyasthenia G93.3 (epidemic) (postinfectious) :*Syndrome - see also Disease :::postviral NEC G93.3 ::::[[fatigue]] G93.3<ref name="icd10data">{{Cite web|url=https://www.icd10data.com/ICD10CM/Codes/G00-G99/G89-G99/G93-/G93.3 | title = 2019 ICD-10-CM Diagnosis Code G93.3: Postviral fatigue syndrome|website=icd10data.com|access-date=2019-04-13}}</ref> ====<span id="ICD11">ICD-11 (2018)</span>==== *'''<u>8E49 Postviral fatigue syndrome</u>''' '''All ancestors up to top''' *08 Diseases of the nervous system :*Other disorders of the nervous system ::*8E49 Postviral fatigue syndrome '''Inclusions''' ::*Benign myalgic encephalomyelitis ::*chronic fatigue syndrome<ref name="icd11" /> The ICD-11 no longer has a fatigue syndrome of any kind in the "Mental and Behavioral Disorders" section. [[Neurasthenia]] is not mentioned in any section. In response to the [[Wessely school|Wessely school's]] textbook which incorrectly stated that [[chronic fatigue syndrome]] (CFS) can be classed as a mental disorder, Audre L'Hours from WHO has stated that a disorder can only be classed under one rubic, and that all WHO countries must follow the WHO classification of CFS or ME as a [[Nervous system|neurologica]]l disorder only.<ref>{{Cite web|url=https://publications.parliament.uk/pa/ld200304/ldhansrd/vo040122/text/40122-12.htm | title = Lords Hansard text for 22 Jan 2004 (240122-12) | last =Westminster | first=Department of the Official Report (Hansard), House of Lords|website=publications.parliament.uk|access-date=2018-10-14}}</ref> Dr Tarun Dua proposed moving Myalgic Encephalomyelitis from the [[:Category:Neurological diseases and disorders|Neurological Disorders]] section to ''Symptoms, signs or clinical findings of the musculoskeletal system'', which would have re-classified ME/CFS as [[medically unexplained physical symptoms]] rather than a specific, neurological disease: this proposal was rejected.<ref>{{Cite news | url=https://dxrevisionwatch.com/2018/11/22/update-on-the-status-of-the-classification-of-pvfs-me-and-cfs-for-icd-11-part-three-who-rejects-dr-duas-proposal/ | title = Update on the status of the classification of PVFS, ME and CFS for ICD-11: Part Three: WHO rejects Dr Dua’s proposal | last =DX Revision Watch | first = | date = 2018-11-22|work=|access-date=2018-11-23|archive-url=|archive-date=|url-status=|language=en-US}}</ref> ===Chronic fatigue syndrome=== ==== ICD-10-CM ==== '''United States''' *'''R53.82''' is for [[Chronic fatigue]], unspecified under ICD-10-CM Diagnosis Code.<ref name=":1" /> '''R53.82 (ICD-10-CM) is grouped within Diagnostic Related Group(s) (MS-DRG v35.0):''' :*947 Signs and symptoms with mcc :*948 Signs and symptoms without mcc :Convert R53.82 to ICD-9-CM :Code History :*2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM) :*2017 (effective 10/1/2016): No change :*2018 (effective 10/1/2017): No change :Code annotations containing back-references to R53.82: :*Type 1 Excludes: G93.3 :Diagnosis Index entries containing back-references to R53.82: :*Fatigue R53.83 :::chronic R53.82 :*Syndrome - see also Disease :::fatigue ::::chronic R53.82<ref name=":1">{{Cite web|url=https://www.icd10data.com/ICD10CM/Codes/R00-R99/R50-R69/R53-/R53.82 | title = 2018/2019 ICD-10-CM Diagnosis Code R53.82: Chronic fatigue, unspecified|website=icd10data.com|language=en|access-date=2018-10-14}}</ref> ==== ICD-11 (2019) ==== *'''<u>8E49 Postviral fatigue syndrome</u>''' '''All ancestors up to top''' *08 Diseases of the nervous system :*Other disorders of the nervous system ::*8E49 Postviral fatigue syndrome '''Inclusions''' ::*Benign myalgic encephalomyelitis ::*chronic fatigue syndrome<ref name="icd11" /> ==DSM== The American diagnostic manual for mental and behavioral disorders, known as the DSM-5, does not contain include myalgic encephalomyelitis or chronic fatigue syndrome, because they are not mental health conditions.<ref name="DSM-5">{{Cite book | title=Diagnostic and Statistical Manual of Mental Disorders (DSM-5®)|pages=|url=https://books.google.com/books/about/Diagnostic_and_Statistical_Manual_of_Men.html?id=-JivBAAAQBAJ|isbn=9780890425572|edition=5th revision|language=|title-link=|access-date=| date = 2013 |publisher=American Psychiatric Pub | last = American Psychiatric Association | first=|others=|oclc=|quote=|archive-url=|archive-date=|location=Washington, D.C. | editor-last = | editor-first = |editor1-link=|editor-last2=|editor-first2=}}</ref> == History with Fibromyalgia == The WHO ICD-10 lists [[fibromyalgia]] as a "disease of the [[musculoskeletal system]] and connective tissue," diagnostic code M79.7.<ref>{{Cite web|url=https://icd.who.int/browse10/2016/en#/M79.7 | title = Fibromyalgia - ICD-10 | last =World Health Organization | first= | authorlink = World Health Organization | date = 2016 | website = icd.who.int|archive-url=|archive-date=|url-status=|access-date=2019-04-14}}</ref> === ICD Diagnostic coding === ====ICD-10-CM==== *'''M79.7 Fibromyalgia''' ::Fibromyositis ::Fibrositis ::Myofibrositis<ref>[http://apps.who.int/classifications/icd10/browse/2016/en#/M79.7 M79.7 Fibromyalgia - ICD-10 Version:2016]</ref> In 2015, the [[United States]] adopted the 1992 ICD-10 and fibromyalgia as a diagnosis.<ref name="ICD10-cm-fibro">[http://www.icd10data.com/ICD10CM/Codes/M00-M99/M70-M79/M79-/M79.7 2015/16 ICD-10-CM Diagnosis Code M79.7]</ref><ref>[http://nationalpainreport.com/the-health-care-industry-finally-recognizes-fibromyalgia-8827637.html The Health Care Industry Finally Recognizes Fibromyalgia - National Pain Report - Sept. 30, 2015]</ref> ==== ICD-11 (2019) ==== [[Fibromyalgia]] was renamed to '''Chronic Widespread Pain''' in the ICD-11 update, with fibromyalgia retained as an indexed term. The ICD-11 uses diagnostic code ''MG30.1 Chronic widespread pain'' for fibromyalgia.<ref name="ICD11-fibro">{{Cite web|url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/849253504 | last =World Health Organization | first= | authorlink = World Health Organization | title = MG30.01 Chronic Widespread Pain|website=ICD-11 Mortality and Morbidity Statistics|access-date=2018-12-18}}</ref> *'''MG30.01 Chronic widespread pain''' '''Parent''' ::MG30.0 Chronic primary pain '''Description''' :"Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress ([[anxiety]], anger/frustration or [[depression|depressed mood]]) or functional disability (interference in daily life activities and reduced participation in social roles). CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions and there are features consistent with nociplastic pain and identified psychological and social contributors."<ref name="ICD11-fibro" /> '''Inclusions''' :*Fibromyalgia '''Exclusions''' :*Acute pain (MG31)<ref name="ICD11-fibro" /> ===DSM=== Fibromyalgia is not included in the American DSM-5 manual of mental and behavioral disorders because it is a physical rather than psychological illness.<ref name="DSM-5" /> Fibromyalgia is also classified within a chapter of physical health conditions, and not in the mental and behavioral chapter of the ICD diagnostic manual.<ref name="ICD11-fibro"/> == Online presence == The WHO uses social media in many languages. === English language === *[https://www.facebook.com/WHO Facebook] *[https://www.instagram.com/who/ Instagram] *[https://twitter.com/who Twitter] *[http://www.who.int Website] ==See also== *[[Myalgic encephalomyelitis]] *[[Chronic fatigue syndrome]] *[[Fibromyalgia]] == Learn more == *2009, [http://www.hfme.org/PDF/WHO_ICD_ME_and_CFS_Short.pdf WHO ICD in relation to M.E. and "CFS"—Short] via [[The Hummingbirds' Foundation for ME]] *[https://en.wikipedia.org/wiki/History_of_chronic_fatigue_syndrome#International_classifications History of Chronic Fatigue Syndrome - International Classifications] via Wikipedia ==References== {{Reflist}} [[Category: Global health]] [[Category: International medical and health organizations]] <references />
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