Diagnosing Chronic Fatigue Syndrome - Is the Canadian Way Better?
A call is going out from advocates for the U.S. to adopt the Canadian criteria for diagnosing chronic fatigue syndrome (CFS or ME/CFS).
Right now, the U.S. uses criteria set by the CDC, which are:
- Unexplained, persistent fatigue that's not relieved by rest
- Four or more of the following, for six months or more:
- Impaired memory or concentration
- Post-exertional malaise
- Unrefreshing sleep
- Muscle pain
- Multi-joint pain without swelling or redness
- Headaches of a new type or severity
- Sore throat that's frequent or recurring
- Tender cervical or axillary lymph nodes
The Canadian criteria covers a broader array of symptoms. Here's a summarized list:
- Unexplained, persistent fatigue
- Post-exertional malaise and/or fatigue
- Sleep dysfunction, including unrefreshing sleep or rhythm disturbances
- Pain in muscles & joints that can be widespread and migratory
- 2 or more neurological/cognitive manifestations
- At least one symptoms from two of the following categories:
- Autonomic manifestations (such as neurally mediated hypotension, irritable bowel syndrome and heart palpitations)
- Neuroendocrine manifestations (such as intolerance of heat and cold, and worsening of symptoms with stress)
- Immune manifestations (such as recurrent flu-like symptoms, and sensitivities to food, medications or chemicals)
- Illness persists for at least 6 months
While on their face they might not seem vastly different, it's important to note that the Canadian criteria recognizes a broader range of cognitive problems, which both includes more people and could help in proving disability due to those symptoms. It also requires post-exertional malaise, which is considered by many experts to be the hallmark of ME/CFS. The type of pain and sleep dysfunctions are better defined and broader as well.
Also notice that classifying symptoms under clinical categories (autonomic, neuroendocrine & immune) helps them make sense, instead of being an odd cluster of symptoms that seem to bear no relationship to each other.
- Read more about the Canadian criteria.
- Learn more about the campaign to adopt the Canadian criteria in the U.S.
Do you think the U.S. should adopt these criteria? Would it help doctors recognize and understand ME/CFS? Share your thoughts here or in About.com's Fibromyalgia & Chronic Fatigue Syndrome forum..
Comments
I recently came across the Canadian definition and I think it is a better assessment tool. CFS/FMS symptoms change the longer a person has the condition. Using the US definition, a person can be completely debilitated but no longer meet the criteria. That’s not fair, especially to long-term sufferers who managed to manage their symptoms somewhat, perhaps extending their time in the workforce.
Thank you for posting information about the Canadian consensus document.
The Canadian document also includes a bibliography of refereed-journal (that means formally scientific) articles on the BIOLOGICAL causes of symptoms in ME/CFS - which the CDC refuses to admit to. A requirement for assuming the disease is psychologically caused is that there be no biological causation, this bibliography shows that’s simply not true. See this link:
http://www.cfids-me.org/cfscc/canbib06.html.
Also, the Canadian document has a list of useful tests - and many of these are actually PROHIBITED by the CDC!
http://www.cfids-me.org/consensustests.html
Compare that with:
http://www.cfids-me.org/cdctests.html
We have to be worried because the CDC is now actively promoting the British “NICE” guidelines, which are anything but - they favor Cognitive Behaviour Therapy (convincing people through talking therapy that they aren’t really sick at all) and Graded Exercise Therapy (which will get you up and running in no time, once you accept you’re not really that sick). It has been shown to be a failure, but the British medical system, through NICE, now requires even the sickest patients to go through this before they can get disability or any further treatment.
And this is what the CDC thinks is a good idea. They will say that they don’t MEAN it like the British, but if you follow their “professional” education plans on their website, it is exactly where they are going. For example, CDC says that even the sickest patients can exercise their way back to being self-sufficient - just start with hand exercises, for example. (This is in their “CFS Toolkit for Professionals.”)
Those of us with a “CFS” diagnosis in the U.S. are at an alarming crossroads. There are fewer and fewer knowledgeable doctors to treat patients, and the CDC is moving closer to the British psychiatric position.
We really need as many people as possible to see the Canadian guidelines, and I would very much like to see it presented to Congress. I have my political contact; I just need signatures.
I think the real issue about the Canadian consensus document is that it is concise and ready to use. It has detail that no other document has in order to diagnose and treat a CFS patient.
I encourage anyone who will listen to print a copy and read it if possible. I know that some are just too brainfogged to do this. But for those who can, once you read it, you’ll know this is the perfect tool for your physician to use to help you and others… assuming he/she is a “believer” and willing to learn.
Nancy
eClaire - You made a great point. When fibro first his the airwaves, they stated that the symptoms were not progressive. They wax and wane, as anyone who had either of these illnesses knows. Yes, it can get worse…is that not progressive?
I hope they do accept the Canadian way in making a determination.
There is also a Canadian Consensus document for Fibromyalgia.