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Hyperacusis

2022-04-02T23:19:30Z

YourFriendlyNeighbourhoodEditor:Fixed some typos and grammatical errors

'''Hyperacusis''' or '''severe noise sensitivity''' or '''severe sound sensitivity''' is a hearing disorder that makes ordinary sounds or noise feel unbearably loud, causing discomfort, excessive annoyance, fear, or [[pain]].<ref name="WebMD" /><ref name="PMC5157031" /> Hyperacusis is considered to be a reduced tolerance to noises that don't seem to be noticeable to others and may be limited to certain types of noise; for example: a car engine, a fridge, or a vacuum cleaner.<ref name="bh">{{Cite web|url=https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hearing-problems-reduced-tolerance-to-sound|title=Hearing problems - hyperacusis|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=Better Health Channel|archive-url=|archive-date=|url-status=|access-date=2022-01-10}}</ref><ref name="WebMD">{{Cite web|url=https://www.webmd.com/brain/sound-sensitivity-hyperacusis|title=What Is Sound Sensitivity (Hyperacusis)?|last=Konstantinovsky|first=Michelle|website=WebMD|language=en|access-date=2022-01-10}}</ref><ref name="NHS" /> [[File:UNREST Film Still Whitney.png|250px|right|thumb|[[Whitney Dafoe]] is a very [[Severe and very severe ME|severely ill ME]] patient that must wear ear protection daily, even indoors]]

[[File:Chronically_Hopeful_Char_Profile_Pic.jpg|250px|thumb|right|Char, author at [[Chronically Hopeful]], writes of sound sensitivity which she suffers daily but becomes worse during a flare.<ref name="char">{{Cite news|url=http://chronicallyhopeful.com/mecfs-flares/|title=ME/CFS flares: what do they feel like and how to cope|last=x|first=Char|date=2017-11-02|work=Chronically Hopeful|access-date=2018-10-11|archive-url=|archive-date=|url-status=|language=en-GB}}</ref> Patients use ear protection]]
Everyday sounds can be unbearable to the sufferer but will have no effect on others.

[[Tinnitus]] is also common in people with hyperacusis.<ref name="WebMD" />

===Noise sensitivity ===
Noise sensitivity is not the same as hyperacusis.

While noise sensitivity is very common in the general population, hyperacusis is not.<ref name="WebMD" /><ref name="PMC5157031" />

==Prevalence==
Some degree of noise sensitivity is common, occurring in 20-40% of people, with high noise sensitivity affecting 12% to 15% of people.<ref name="WebMD" /><ref name="PMC5157031" />

Estimates of hyperacusis prevalence vary considerably, from less than 1 in 1,000 people to 4-17% in certain groups, hyperacusis is generally regarded as rare while noise sensitivity is common.<ref name="WebMD" /><ref name="PMC5157031" /><ref name="Ren2021">{{Cite journal|title=Prevalence of Hyperacusis in the General and Special Populations: A Scoping Review|date=2021|url=https://www.frontiersin.org/article/10.3389/fneur.2021.706555|journal=Frontiers in Neurology|volume=12|pages=1540|last=Ren|first=Jing|last2=Xu|first2=Tao|last3=Xiang|first3=Tao|last4=Pu|first4=Jun-mei|last5=Liu|first5=Lu|last6=Xiao|first6=Yan|last7=Lai|first7=Dan|doi=10.3389/fneur.2021.706555|issn=1664-2295}}</ref>

Hyperacusis is more common in certain groups, including professional musicians or music students, people with autism, William's syndrome or certain other conditions, adolescents and older people, and is more common in females.<ref name="Ren2021" />

==Hyperacusis in ME/CFS==

=== Symptom recognition===
Hyperacusis is a symptom of ME recognized in the [[International Consensus Criteria]]'s '''neurosensory symptoms''', and counts towards the neurological symptoms required to diagnose ME or atypical ME (which is when symptoms are partially rather than fully met).<ref name="ICC2011primer">{{citation
| last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers
| last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande
| last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir
| last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas
| last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick
| last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell
| last7 = Staines | first7 = D | authorlink7 = Donald Staines
| last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles
| last9 = Speight | first9 = N | authorlink9 = Nigel Speight
| last10 = Vallings | first10= R | authorlink10= Rosamund Vallings
| last11 = Bateman | first11= L | authorlink11= Lucinda Bateman
| last12 = Bell | first12= DS | authorlink12= David Bell
| last13 = Carlo-Stella | first13= N | authorlink13= Nicoletta Carlo-Stella
| last14 = Chia | first14= J | authorlink14= John Chia
| last15 = Darragh | first15= A | authorlink15= Austin Darragh
| last16 = Gerken | first16= A | authorlink16= Anne Gerken
| last17 = Jo | first17= D | authorlink17= Daehyun Jo
| last18 = Lewis | first18= DP | authorlink18= Donald Lewis
| last19 = Light | first19= AR | authorlink19= Alan Light
| last20 = Light | first20= KC | authorlink20= Kathleen Light
| last21 = Marshall-Gradisnik | first21= S | authorlink21= Sonya Marshall-Gradisnik
| last22 = McLaren-Howard | first22= J | authorlink22= John McLaren-Howard
| last23 = Mena | first23= I | authorlink23= Ismael Mena
| last24 = Miwa | first24= K | authorlink24= Kunihisa Miwa
| last25 = Murovska | first25= M | authorlink25= Modra Murovska
| last26 = Stevens | first26= SR | authorlink26= Staci Stevens
| title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners
| date = 2012
| isbn = 978-0-9739335-3-6
| url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf
}}</ref>{{Rp|7}}

Hypersensitivity to noise is mentioned as part of the "overload phenomenon" diagnostic symptom in the [[Canadian Consensus Criteria]]'s Neurological/Cognitive Manifestations.

The same section also refers to "sensory disturbances".<ref name="canadianconsensus-CCC" />{{Rp|11}} It can also be rated using the Symptom Severity and Severity Hierarchy Chart (Appendix 3), although [[photophobia|light sensitivity]], noise, [[odor sensitivities|odors]] is combined into one item.<ref name="canadianconsensus-CCC" />{{Rp|102-103}}

Hyperacusis is recognized in the in the '''Visual and Auditory Disturbances''' part of the Signs and Symptoms list in Appendix 4.<ref name="canadianconsensus-CCC">{{Citation
| last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers
| last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain
| last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir
| last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson
| last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas
| last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner
| last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested
| last8 = Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry
| last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi
| last10 = Powles | first10 = A C Peter | authorlink10 = A C Peter Powles
| last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey
| last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande
| title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols
| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | page = 7-115
| date = 2003
| pmid =
| doi = 10.1300/J092v11n01_02
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref>{{Rp|104}}

There is no reference to noise sensitivity in the more commonly used [[Fukuda criteria]].

==Notable studies==
*1992, Ocular manifestations of chronic fatigue and immune dysfunction syndrome<ref name="Potaznick1992">{{Cite journal|title=Ocular manifestations of chronic fatigue and immune dysfunction syndrome|date=1992-10-01|url=https://doi.org/10.1097/00006324-199210000-00011|journal=Optometry and vision science|volume=69|issue=10|pages=811–814|last=Potaznick|first=W|last2=Kozol|first2=N|doi=10.1097/00006324-199210000-00011|pmid=1437004|issn=1538-9235}}</ref> - [https://pdfs.journals.lww.com/optvissci/1992/10000/ocular_manifestations_of_chronic_fatigue_and.11.pdf (Abstract)]

== Possible causes==
Hyperacusis results from the "malfunction of the central auditory pathways and their connections within the [[central nervous system]]".<ref name="PMC5157031">{{Cite journal|title=A window into the brain mechanisms associated with noise sensitivity|date=2016-12-15|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5157031/|journal=Scientific Reports|volume=6|pages=39236|last=Kliuchko|first=Marina|last2=Heinonen-Guzejev|first2=Marja|last3=Vuust|first3=Peter|last4=Tervaniemi|first4=Mari|last5=Brattico|first5=Elvira|doi=10.1038/srep39236|pmc=5157031|pmid=27976708|issn=2045-2322}}</ref>

*Hearing loss is a significant risk factor for both hyperacusis and tinnitus, although many people with hyperacusis have normal hearing.
* Damage to the inner ear caused by ageing
* One-off or ongoing exposure to very loud noise
* Damage to the facial nerve
* Ear surgery
* Head injury
* William's syndrome
* [[Autism]] spectrum
* Neurologic diseases including [[Ménière's disease]], [[migraine]] and [[Lyme disease]]
* certain medications.<ref name="WebMD" /><ref name="bh" /><ref name="NHS">{{Cite web|url=https://www.nhs.uk/conditions/hyperacusis/|title=Noise sensitivity (hyperacusis)|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=2017-10-18|website=[[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2022-01-10}}</ref>

It is not fully understand how ME/CFS causes hyperacusis.

==Potential treatments==
There is no cure, but there are ways to manage hyperacusis.<ref name="bh" />

Ear plugs or ear defenders should only be used when essential since they can make hyperacusis worse if used too much.<ref name="NHS" />

==Learn more==
*[https://www.nhs.uk/conditions/hyperacusis/ Hyperacusis (sound sensitivity)] - NHS
* [http://chronicallyhopeful.com/mecfs-flares/ ME/CFS flares: what do they feel like and how to cope]

==See also==
* [[Tinnitus]]
* [[Hypersensitivity]]
* [[Photophobia]]
* [[Central sensitization]]

==References==
{{Reflist}}

[[Category:Diagnoses]]
[[Category:Neurological signs and symptoms‎]]
[[Category:Sensitivity signs and symptoms]]
[[Category:Aural signs and symptoms]]
[[Category:Potential comorbidities]]

Idiopathic chronic fatigue

2022-04-02T22:46:52Z

YourFriendlyNeighbourhoodEditor:Changed small typos and punctuation errors

[[File:Chronic-Fatigue-Patil.jpg|3206px|right|thumb|Source: Chronic fatigue syndrome: A review (Balachander et al.) 2014.<ref name=":02">{{Cite journal|last=Singh|first=Shubh Mohan|last2=Sarkar|first2=Siddharth|last3=Rao|first3=Pradyumna|last4=Balachander|first4=Srinivas|date=2014-07-01|title=Chronic fatigue syndrome: A review|url=http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2014;volume=7;issue=4;spage=415;epage=422;aulast=Balachander|journal=Medical Journal of Dr. D.Y. Patil University|language=en|volume=7|issue=4|pages=415|doi=10.4103/0975-2870.135252|issn=0975-2870|quote=|author-link=|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref>]]
'''Idiopathic chronic fatigue''' or ICF is long lasting [[chronic fatigue]] that is not caused by an underlying medical condition or psychiatric illness.<ref name="Valiani2019" /> Patients with idiopathic chronic fatigue do not fulfil the criteria for [[chronic fatigue syndrome]] (CFS).<ref name="Son2019" /> The word ''idiopathic'' reflects an unknown underlying cause, meaning that the chronic fatigue is a [[Medically unexplained symptoms|medically unexplained symptom]].<ref name="Valiani2019" /><ref name=":0">{{Cite web|url=https://www.docsopinion.com/2017/11/08/causes-fatigue-tiredness-chronic-fatigue/|title=19 Important Causes of Fatigue - Tiredness and Chronic Fatigue Explained|last=Sigurdsson MD|first=Alex F.|authorlink=|last2=|first2=|authorlink2=|date=Nov 8, 2017|website=www.docsopinion.com|archive-url=|archive-date=|url-status=|access-date=2019-01-30}}</ref>

==Differences from chronic fatigue syndrome==
[[File:ChronicFatigueSyndrome-IdiopathicChronicFatigue-Differences.jpg|left|thumb|Chronic Fatigue Syndrome (CFS) is a distinct neurological disease, and is not the same as chronic fatigue, or long-term fatigue with no known cause (ICF).<ref name="Son2019" />

''Source: Son, C-G (2019). Differential diagnosis between “chronic fatigue” and “chronic fatigue syndrome”. Integrative Medicine Research, 8(2), 89-91. Suggested algorithm for chronic fatigue, ICF and CFS. License: CC-BY-ND-NC.'']]
{{clear}}
<div style="column-count:2;webkit-column-count:2;-moz-column-count: 2;" class="hlist">
*Idiopathic chronic fatigue is not a distinct illness or disease.

*Idiopathic chronic fatigue only requires the symptom of [[chronic fatigue|chronic fatigue.]]<ref name="Son2019" />
*Idiopathic chronic fatigue is more common in the elderly and becomes more common with ageing.<ref name="Valiani2019" />
*Chronic fatigue syndrome is a [[neurological disorder|neurological disease]].
*[[Chronic fatigue syndrome]] is a multi-systemic illness with a wide variety of symptoms, which may include: immune symptoms, cardiovascular symptoms, [[post-exertional malaise]], [[headache]]s or [[migraine]]s, and [[chronic pain]].<ref name="Son2019" /><ref name="fukuda1994">{{Cite journal|last=Fukuda|first=K.|author-link=Keiji Fukuda|last2=Straus|first2=S. E.|author-link2=Stephen Straus|last3=Hickie|first3=I.|author-link3=Ian Hickie|last4=Sharpe|first4=M. C.|author-link4=Michael Sharpe|last5=Dobbins|first5=J. G.|author-link5=James Dobbins|last6=Komaroff|first6=A.|author-link6=Anthony Komaroff|date=1994-12-15|title=The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group|url=https://www.researchgate.net/profile/Michael_Sharpe2/publication/247808895_The_Chronic_Fatigue_Syndrome_A_Comprehensive_Approach_to_Its_Definition_and_Study/links/0c96053201643bfc4b000000/The-Chronic-Fatigue-Syndrome-A-Comprehensive-Approach-to-Its-Definition-and-Study.pdf|journal=Annals of Internal Medicine|volume=121|issue=12|pages=953–959|issn=0003-4819|pmid=7978722|via=|publisher=American College of Physicians}}</ref>
*Chronic fatigue syndrome is most common in teenagers and working age adults.
*Idiopathic chronic fatigue is generally considered less disabling.<ref name="Valiani2019" />
</div>

== Notable studies ==
*1992, Chronic tiredness and idiopathic chronic fatigue--a connection?<ref name="Simpson1992">{{Cite journal |url=https://pubmed.ncbi.nlm.nih.gov/1574202/|title=Chronic Tiredness and Idiopathic Chronic Fatigue--A Connection?|last=Simpson|first=LO|authorlink=|date=Mar 1992|journal=New Jersey medicine|pages=211‐216|language=en|pmid=1574202|archive-url=|archive-date=|url-status=|access-date=2020-05-22|volume=89|issue=3}}</ref> - [https://www.ncbi.nlm.nih.gov/pubmed/1574202 (Abstract)]
* 1999, Idiopathic chronic fatigue and chronic fatigue syndrome: a comparison of two case-definitions<ref name="carrieri1999">{{Cite web|url=https://pubmed.ncbi.nlm.nih.gov/10721210/|title=Idiopathic Chronic Fatigue and Chronic Fatigue Syndrome: A Comparison of Two Case-Definitions|last=C|first=Arpino|last2=Mp|first2=Carrieri|date=1999|website=Annali dell'Istituto superiore di sanita|language=en|pmid=10721210|access-date=2020-05-22|last3=G|first3=Valesini|last4=E|first4=Pizzigallo|last5=P|first5=Rovere|last6=U|first6=Tirelli|last7=F|first7=Conti|last8=P|first8=Dialmi|last9=A|first9=Barberio}}</ref> - [https://europepmc.org/article/med/10721210 (Abstract)]
*2004, Disability in chronic fatigue syndrome and idiopathic chronic fatigue<ref name="carrico2004">{{Cite journal|last=Carrico|first=Adam W.|last2=Jason|first2=Leonard A.|last3=Witter|first3=Elizabeth|last4=Torres-Harding|first4=Susan|date=2004|title=Disability in Chronic Fatigue Syndrome and Idiopathic Chronic Fatigue|url=https://rdsjournal.org/index.php/journal/article/view/14|journal=Review of Disability Studies: An International Journal|language=en|volume=1|issue=1|issn=1552-9215}}</ref> - [http://128.171.57.22/bitstream/10125/58528/46.pdf (Full text)]
*2007/updated 2009, Traditional Chinese medicinal herbs for idiopathic chronic fatigue and chronic fatigue syndrome<ref>{{Cite journal|last=Adams|first=Denise|last2=Wu|first2=Taixiang|last3=Tai|first3=Shusheng|last4=Wiebe|first4=Natasha|last5=Vohra|first5=Sunita|date=2007|title=Traditional Chinese medicinal herbs for idiopathic chronic fatigue and chronic fatigue syndrome|url=https://www.cochranelibrary.com/content?templateType=full&urlTitle=%2Fcdsr%2Fdoi%2F10.1002%2F14651858.CD006348&doi=10.1002%2F14651858.CD006348&type=cdsr&contentLanguage=|journal=Cochrane Database of Systematic Reviews|language=en|issue=1|doi=10.1002/14651858.CD006348|issn=1465-1858}}</ref> - [https://www.cochranelibrary.com/content?templateType=full&urlTitle=/cdsr/doi/10.1002/14651858.CD006348&doi=10.1002/14651858.CD006348&type=cdsr&contentLanguage= (Full text)]
*2012, Fatigue severity of patients with idiopathic chronic fatigue compared to healthy subjects<ref name="Lee2012">{{Cite journal|last=Lee|first=Nam Hun|last2=Son|first2=Chang Gue|date=2012-09-01|title=Fatigue severity of patients with idiopathic chronic fatigue compared to healthy subjects|url=http://www.sciencedirect.com/science/article/pii/S0254627213600370|journal=Journal of Traditional Chinese Medicine|language=en|volume=32|issue=3|pages=355–357|doi=10.1016/S0254-6272(13)60037-0|issn=0254-6272}}</ref> - [https://www.sciencedirect.com/science/article/pii/S0254627213600370/pdf?md5=e8df9e93c64cbe130e27bdbf3b0edcc1&pid=1-s2.0-S0254627213600370-main.pdf&_valck=1 (Full text)]
* 2013, Idiopathic chronic fatigue in older adults is linked to impaired mitochondrial content and biogenesis signaling in skeletal muscle<ref name="Son2013">{{Cite journal|last=Wawrzyniak|first=Nicholas R.|last2=Joseph|first2=Anna-Maria|last3=Levin|first3=David G.|last4=Gundermann|first4=David M.|last5=Leeuwenburgh|first5=Christiaan|last6=Sandesara|first6=Bhanuprasad|last7=Manini|first7=Todd M.|last8=Adhihetty|first8=Peter J.|date=2016-07-18|title=Idiopathic chronic fatigue in older adults is linked to impaired mitochondrial content and biogenesis signaling in skeletal muscle|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288142/|journal=Oncotarget|volume=7|issue=33|pages=52695–52709|doi=10.18632/oncotarget.10685|issn=1949-2553|pmc=5288142|pmid=27447862}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288142/ (Full text)]
* 2013, Chronic fatigue syndrome 5 years after giardiasis: differential diagnoses, characteristics and natural course<ref>{{Cite journal|last=Mørch|first=Kristine|last2=Hanevik|first2=Kurt|last3=Rivenes|first3=Ann C.|last4=Bødtker|first4=Jørn E.|last5=Næss|first5=Halvor|last6=Stubhaug|first6=Bjarte|last7=Wensaas|first7=Knut-Arne|last8=Rortveit|first8=Guri|last9=Eide|first9=Geir E.|date=2013-02-12|title=Chronic fatigue syndrome 5 years after giardiasis: differential diagnoses, characteristics and natural course|url=https://doi.org/10.1186/1471-230X-13-28|journal=BMC Gastroenterology|language=en|volume=13|issue=1|pages=28|doi=10.1186/1471-230X-13-28|issn=1471-230X|pmc = 3598369|pmid=23399438}}</ref> - [https://link.springer.com/article/10.1186/1471-230X-13-28 (Full text)]
* 2013, An open-label study of effects of acupuncture on chronic fatigue syndrome and idiopathic chronic fatigue: study protocol for a randomized controlled trial<ref name="Kim2013">{{Cite journal|last=Kim|first=Jung-Eun|last2=Hong|first2=Kwon-Eui|last3=Kim|first3=Hyeong-Jun|last4=Choi|first4=Jin-Bong|last5=Baek|first5=Yong-Hyeon|last6=Seo|first6=Byung-Kwan|last7=Lee|first7=Sanghun|last8=Kang|first8=Kyung-Won|last9=Lee|first9=Min-Hee|date=2013-05-21|title=An open-label study of effects of acupuncture on chronic fatigue syndrome and idiopathic chronic fatigue: study protocol for a randomized controlled trial|url=https://doi.org/10.1186/1745-6215-14-147|journal=Trials|volume=14|issue=1|pages=147|doi=10.1186/1745-6215-14-147|issn=1745-6215|pmc = 3663812|pmid=23693129}}</ref> - [https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-14-147 (Full text)]
* 2014, Chronic fatigue syndrome: A review<ref name=":02" /> ([http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2014;volume=7;issue=4;spage=415;epage=422;aulast=Balachander Full Text])
* 2016, Metabolic Rate and Perceived Exertion of Walking in Older Adults With Idiopathic Chronic Fatigue<ref name="Valiani2019">{{Cite journal|last=Manini|first=Todd M.|author-link=|last2=Knaggs|first2=Jeffrey D.|author-link2=|last3=Corbett|first3=Duane B.|author-link3=|last4=Valiani|first4=Vincenzo|author-link4=Vincenzo Valiani|author-link5=|date=2016-11-01|title=Metabolic Rate and Perceived Exertion of Walking in Older Adults With Idiopathic Chronic Fatigue|url=https://academic.oup.com/biomedgerontology/article/71/11/1444/2577047|journal=The Journals of Gerontology: Series A|language=en|volume=71|issue=11|pages=1444–1450|doi=10.1093/gerona/glw108|issn=1079-5006|quote=|via=}}</ref> [https://academic.oup.com/biomedgerontology/article/71/11/1444/2577047 (Full text)]
* 2019, Differential diagnosis between “chronic fatigue” and “chronic fatigue syndrome”<ref name="Son2019">{{Cite journal|last=Son|first=Chang-Gue|date=Jun 2019|title=Differential diagnosis between "chronic fatigue" and "chronic fatigue syndrome".|url=https://europepmc.org/articles/PMC6522773/|journal=Integrative medicine research|volume=8|issue=2|pages=89–91|doi=10.1016/j.imr.2019.04.005|issn=2213-4220|pmid=31193269|quote=|via=}}</ref> - [https://europepmc.org/articles/PMC6522773/ (Full source)]

== See also ==
* [[Chronic fatigue]]
* [[Chronic fatigue syndrome]]
* [[Fatigue]]
* [[Medically unexplained symptoms]]

== Learn more ==
* [https://www.docsopinion.com/2017/11/08/causes-fatigue-tiredness-chronic-fatigue/ 19 Important Causes of Fatigue – Tiredness and Chronic Fatigue Explained]<ref name=":0" />

== References ==
{{Reflist}}
[[Category:Disease]]