Introduction
Myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS) or ME/CFS remains an elusive diagnosis to most family and primary care practitioners. There are currently no Federal Drug Administration (FDA) approved treatments specific to this disease.
Clinical guidance has often recommended cognitive behavioral (CBT) and graded exercise therapy (GET), but these therapies are inappropriate and potentially harmful for patients with ME/CFS.1 In 2015, the Institute of Medicine (IOM, now called the National Academy of Medicine) issued new clinical diagnostic criteria for ME/CFS and summarized the growing evidence of biological impairment.
2 Since then, the National Institutes of Health (NIH) has funded three Centers of Excellence to study ME/CFS,3 a pediatric ME/CFS primer has been published,4 and the Centers for Disease Control (CDC) has updated the diagnostic and treatment information on its website.5 Family physicians have a critical role to play in providing early diagnosis and effective treatment of this disabling disease.
History
ME/CFS has existed throughout the twentieth century but has been both maligned and misunderstood as a result of a lack of research, a paucity of diagnostic tests and FDA approved treatments, and because of non-specific diagnostic criteria that included patients with other diseases. As a result, patients with ME/CFS have remained unidentified or have been misdiagnosed and thus have struggled to get proper clinical care. Further complicating our understanding of ME/CFS, a significant number of ME/CFS research studies have focused on the role of psychogenic factors in the development and perpetuation of the disease
.6 These studies were based on the unproven theory that the severity and poor prognosis of ME/CFS was due to the patients’ harboring a fear of activity and thus becoming deconditioned and that these could be reversed with CBT and GET.
7 Unfortunately, the most commonly recommended treatments in ME/CFS clinical guidance have been CBT and GET, based on these false presumptions.8 Editor’s Note: The NYSAFP Editorial Board, as well as our authors encourage and appreciate feedback from our readers. Please share your clinical experience and comments about this illness or any others that have been featured in this issue.
Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome: What Every Family Physician Needs to Know ME/CFS
