New guidelines on chronic fatigue care
By Bianca Nogrady
Chronic Fatigue Syndrome (CFS) should be considered in the same way as migraine, where there is no clear pathology or diagnostic test but the condition is well recognised and taken seriously by practitioners, an Australian expert says.
Dr Rob Loblay, convenor of a working group that has just published new CFS guidelines, said a good doctor-patient relationship was one of the most important factors in dealing with patients with CFS, and taking the same attitude to these patients as those with migraine would be helpful.
One of the aims of the document, published by the Royal Australian College of Physicians [sic], was to encourage people to avoid using pejorative terms that implied malingering, he said.
Despite the fact that no one had yet been able to find a disease process for CFS, Dr Loblay said the condition was a genuine problem that caused significant suffering and disability.
And despite a lack of a diagnostic test, there were fairly characteristic symptoms, such as difficulty sleeping, muscle pain and impaired concentration. However, fatigue was a common symptom of many diseases, so it was important to exclude other conditions that could be confused with CFS.
Although there was no cure for CFS, medication such as antidepressants and analgesia could be useful, especially with symptoms such as pain and disturbed sleep. But in many cases the best approach was to offer support, empathy and patient education.
The new guidelines have been controversial, with patient groups claiming they trivialise the condition and promote harmful therapies such as graded exercise. They have also objected to the inclusion of treatments such as cognitive behaviour therapy. Although CBT had been shown to be of benefit, the terminology gave some patients the impression their disease was being treated as purely psychological and imagined.
The guidelines, first produced in 1997, had been updated to incorporate feedback from consumers, and to reflect new research, particularly in the area of physical therapy.
MJA 2002; 176 Supplement S17-56
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