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Diagnosis of CFS

There are no specific tests used to diagnose chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). For a doctor to diagnose the syndrome, most of the signs and symptoms described below must be present and other possible causes ruled out.

The seven diagnostic criteria of CFS/ME include:

  1. Fatigue – Unexplained, persistent mental and physical fatigue that substantially reduces your activities.
  2. Malaise or fatigue following exertion – After physical or mental exertion, an abnormally slow recovery time of at least 24 hours and an increase in other symptoms.
  3. Sleep dysfunction*– Sleep does not make you feel refreshed or diminish your fatigue. You may wake up feeling tired even after sleeping for 10 to 12 hours.
  4. Pain* – In the muscles and joints, and unusual, severe headaches.
  5. Brain function problems – You may have trouble concentrating, thinking clearly, remembering things that occurred recently or multi-tasking.
  6. At least one symptom from two of the following three categories:
  • the body’s self regulation system (autonomic nervous system) – symptoms such as light-headedness, extreme pallor, nausea, irritable bowel syndrome, urinary frequency, bladder dysfunction, heart palpitations.
  • the hormonal system (neuroendocrine system) – symptoms such as low body temperature, sweating episodes, recurrent feelings of feverishness and cold extremities, intolerance of extreme heat and cold, marked weight change.
  • the immune system – symptoms include tender lymph glands, recurrent sore throat, recurrent flu-like symptoms, general malaise, new sensitivities to foods, medications or chemicals.

7. The illness is chronic – The illness has been present for at least six months in adults and three months in children. The onset of the illness is usually sudden, but can be gradual.

*A small percentage of patients experience no pain or sleep problems, but in   these cases, no diagnosis except CFS/ME fits.

Ruling Out Other Conditions

Before diagnosing CFS/ME, your doctor must rule out other illnesses and conditions that could explain your fatigue and other symptoms, such as anemia, diabetes, an under-active thyroid gland, HIV, hepatitis, cancer, multiple sclerosis or arthritis. Your doctor may recommend various tests, including blood tests, to rule out such illnesses.

Finding a Doctor

Many people find that it can be difficult to find a doctor that has a good working knowledge of CFS/ME. Ask your family doctor to help you with your illness. Your family doctor may refer you to certain specialists, to rule out other illnesses. Your family doctor can act as your guide, helping you determine the changes you need to make to your life, using the SEEDS of health approach:

Exercise/pacing of activities
Environmental assessment

This approach will help you manage your reduced energy level, pace your activities, improve your diet and sleep habits, establish an exercise routine, set appropriate work patterns, avoid exposure to chemical contaminants and improve your quality of life.

Your family doctor may also want to refer you to the Environmental Health Clinic at Women’s College Hospital. This clinic is the only one in Ontario that specializes in the assessment of CFS/ME. Some support groups, such as the M.E. Association of Ontario and the Canadian National ME/FM Action Network, can also recommend doctors that work well with patients who have CFS/ME.


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Chronic Fatigue Syndrome

Medical description


Living with CFS/ME

Activity and exercise




Pain relief


Coping emotionally

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