Claim: Patients push limits for clues to chronic fatigue syndrome.
Verdict: SUPPORTS

Retrieved passages:
title: Chronic fatigue syndrome
text: guidance can be found at the New York Department of Health. Certain medical conditions can cause chronic fatigue and must be ruled out before a diagnosis of CFS can be given. Hypothyroidism, anemia, coeliac disease (that can occur without gastrointestinal symptoms), diabetes and certain psychiatric disorders are a few of the diseases that must be ruled out if the patient presents with appropriate symptoms. Other diseases, listed by the Centers for Disease Control and Prevention, include infectious diseases (such as Epstein–Barr virus, influenza, HIV infection, tuberculosis, Lyme disease), neuroendocrine diseases (such as thyroiditis, Addison's disease, adrenal insufficiency, Cushing's disease), hematologic

title: Clinical descriptions of chronic fatigue syndrome
text: underlying or contributing conditions that require treatment. The use of tests for diagnosing chronic fatigue syndrome should only be done in the context of protocol-based research. The following routine tests are recommended: The 2007 NICE guideline includes, in addition to panel recommended by the CDC, tests for C-reactive protein (a marker of inflammation), creatine kinase (a muscle-related enzyme), plasma viscosity (optional if ESR done) and serology for celiac disease. Ferritin determination may be performed in children and young people, and in adults only if other tests suggest iron deficiency. The guideline recommends clinical judgment in decisions to perform other tests

title: Clinical descriptions of chronic fatigue syndrome
text: difficulties, sleep disturbance, chronic pain. The guideline requires fatigue to have been present for 4 months in an adult or 3 months in a child. It expects a diagnosis in a child to be made by a pediatrician. The guideline states that a referral to a CFS/ME specialist should be offered immediately to the severely ill. There is no generally accepted diagnostic test to reliably diagnose or exclude chronic fatigue syndrome. The 1994 CDC criteria states diagnostic tests should be directed to confirm or exclude other causes for fatigue and other symptoms. Further tests may be individually necessary to identify

title: Clinical descriptions of chronic fatigue syndrome
text: Syndrome Study Group", led by the Centers for Disease Control and Prevention. These criteria are sometimes called the "Fukuda definition" after the first author (Keiji Fukuda) of the publication. The 1994 CDC criteria specify the following conditions must be met: Clinically evaluated, unexplained, persistent or relapsing chronic fatigue that is: The concurrent occurrence of four or more of the following symptoms, all of which must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue: All other known causes of chronic fatigue must have been ruled out, specifically clinical depression, side

title: Clinical descriptions of chronic fatigue syndrome
text: in 2009. These have been cited in articles and are currently being evaluated, for example, in studies to ascertain differences between patients selected using different case definitions. Developed by a group of 26 individuals from 13 countries and consisting of clinicians, researchers, teaching faculty and an independent patient advocate. Based on the 2003 "Canadian" definition by Carruthers et al., chronic fatigue is no longer required and the six-month waiting period before diagnosis has been dropped. The main symptom is "post-exertional neuroimmune exhaustion" (PENE) i.e. low stamina, rapid fatigability, symptom exacerbation, and variable onset with prolonged recovery; which is also accompanied

title: Clinical descriptions of chronic fatigue syndrome
text: in addition to the standard set. Testing for infections (e.g. Lyme disease, viral hepatitis, HIV, mononucleosis, toxoplasmosis or cytomegalovirus) is only recommended if the patient gives a specific history for this. The NICE guideline discourages routine performance of the head-up tilt test, auditory brainstem response and electrodermal conductivity for the purpose of diagnosis. The National Institute for Health and Clinical Excellence (NICE) in England and Wales states that none of the existing case definitions are based on robust evidence, and no studies have confirmed any case definition to be superior to others. Some researchers say that subtypes of CFS may

title: Clinical descriptions of chronic fatigue syndrome
text: effects of medication, eating disorders and substance abuse. The clinical evaluation should include: Other diagnostic tests have no recognized value unless indicated on an individual basis to confirm or exclude a differential diagnosis, such as multiple sclerosis. The initial chronic fatigue syndrome definition was published in 1988. It is also called the "Holmes definition", after the manuscript's first author. Unlike the 1994 CDC criteria, the Holmes criteria exclude patients with psychiatric diagnoses and require the presence of eight secondary symptoms, not just four. The "Oxford criteria" was published in 1991 and include both CFS of unknown etiology and a subtype

title: Controversies related to chronic fatigue syndrome
text: of 1,500 US primary care providers showed that 90 percent believed CFS can impair quality of life, 20 percent strongly or somewhat agreed that CFS is only in the patient’s head, and 70 percent said not enough information is available to diagnose CFS. A 2008 Norwegian study that explored barriers quality care from experiences by patients suffering from chronic fatigue syndrome concluded, "current medical skepticism and ignorance regarding CFS shapes the context of medical care and the illness experiences of CFS patients, who may feel they neither get a proper assessment nor management." Education of care providers is a proposed

title: Chronic fatigue syndrome treatment
text: of the Belgian government of over 800 CFS patients treated in four reference centers which tested CBT and GET in a clinical setting concluded that although patient motivation for treatment seemed to be high and that in 71% the supervising team considered the patient to have reached their maximal capacity, "No patient had been cured. Therapy provided systematically included CBT and GET. After treatment duration of 41 to 62 hours of rehabilitation per patient of which 83% group based, spread over 6 to 12 months, patients’ subjective feelings of fatigue were improved, but results concerning quality of life were equivocal.

title: Clinical descriptions of chronic fatigue syndrome
text: hundred patients found that the diagnosis could be strengthened by adding two new symptoms (anorexia and nausea) and eliminating three others (muscle weakness, joint pain, sleep disturbance). Other suggested improvements to the diagnostic criteria include the use of severity ratings. A new "empirical definition" of the CDC 1994 criteria was published in 2005. A 2009 evaluation of the 2005 empirical definition compared 27 patients with a prior diagnosis of CFS with 37 patients diagnosed with a Major Depressive Disorder. The researchers reported that "38% of those with a diagnosis of a Major Depressive Disorder were misclassified as having CFS using

title: Clinical descriptions of chronic fatigue syndrome
text: by symptoms from neurological, immune/gastro-intestinal/genitourinary, and energy metabolism/transport impairment categories, and at least a 50% reduction in activity which is described as "mild". National guidelines, based upon some or all of the above diagnostic criteria, have been produced by several national bodies, for example in Australia in 2002 and in the United Kingdom in 2007. The National Institute for Health and Clinical Excellence (NICE) in England and Wales published a multidisciplinary clinical practice guideline in 2007 in which the following criteria are employed: The diagnosis should be reconsidered if none of the following symptoms remain: post-exertional fatigue or malaise, cognitive

title: Clinical descriptions of chronic fatigue syndrome
text: listed for 27 January 2014. The completed report recommends a name change to systemic exertion intolerance disease, a new diagnostic criteria, and some testing. It was published with a lengthy literature review, and various materials, all of which are available at the National Academies of Science website. Clinical descriptions of chronic fatigue syndrome The clinical descriptions of chronic fatigue syndrome (CFS) vary. Different agencies and scientific bodies have produced different guidelines to define the condition, with some overlap of symptoms between descriptions. Aspects of the condition are controversial, with disagreements over etiology, pathophysiology, treatment and naming between medical practitioners, researchers,

title: Chronic fatigue syndrome
text: decreased slow wave sleep, and abnormal heart rate response to tilt table tests suggesting a role of the autonomic nervous system in CFS. However, these results were limited by inconsistency. Some neuroimaging studies have observed prefrontal and brainstem hypometabolism; however, studies have been limited by sample size. Decreased frontal grey matter, and decreased white matter in the brain stem have been observed, as well as decreased global cerebral metabolism; however, these findings have been contradictory. Immunological abnormalities are frequently observed in those with CFS. Decreased NK cell activity is found in CFS patients and correlates with severity of symptoms. CFS

title: Chronic fatigue syndrome
text: Chronic fatigue syndrome Chronic fatigue syndrome (CFS), also referred to as myalgic encephalomyelitis (ME), is a medical condition characterized by long-term fatigue and other persistent symptoms that limit a person's ability to carry out ordinary daily activities. While the cause is not understood, proposed mechanisms include biological, genetic, infectious and psychological. Diagnosis is based on a person's symptoms because there is no confirmed diagnostic test. The fatigue in CFS is not due to strenuous ongoing exertion, is not much relieved by rest and is not due to a previous medical condition.<ref name="ME/CFS Symptoms and Diagnosis"></ref> Fatigue is a common symptom

title: Chronic fatigue syndrome
text: diseases (such as occult malignancy, lymphoma), rheumatologic diseases (such as fibromyalgia, polymyalgia rheumatica, Sjögren's syndrome, giant-cell arteritis, polymyositis, dermatomyositis), psychiatric diseases (such as bipolar disorder, schizophrenia, delusional disorders, dementia, anorexia/bulimia nervosa), neuropsychologic diseases (such as obstructive sleep apnea, parkinsonism, multiple sclerosis), and others (such as nasal obstruction from allergies, sinusitis, anatomic obstruction, autoimmune diseases, some chronic illness, alcohol or substance abuse, pharmacologic side effects, heavy metal exposure and toxicity, marked body weight fluctuation). Persons with fibromyalgia (FM, or fibromyalgia syndrome, FMS), like those with CFS, have muscle pain, severe fatigue and sleep disturbances. The presence of allodynia (abnormal pain responses

title: Fatigue
text: number of times that a person awakens during the night are important. A sleep study may be ordered to rule out a sleep disorder. Depression and other psychological conditions can produce fatigue, so people who report fatigue are routinely screened for these conditions, along with drug abuse, poor diet, and lack of physical exercise, which paradoxically increases fatigue. Basic medical tests may be performed to rule out common causes of fatigue. These include blood tests to check for infection or anemia, a urinalysis to look for signs of liver disease or diabetes mellitus, and other tests to check for kidney

title: Controversies related to chronic fatigue syndrome
text: any physician or clinical pharmacologist familiar with problems of systematic bias in trial execution." A 2006 investigation by a group from the Parliament of the United Kingdom found there was not enough support in the UK for CFS patients in terms of access to government benefits and health care. Sufferers describe the struggle for healthcare and legitimacy due to what they consider to be bureaucratic denial of the condition because of its lack of a known etiology. Institutions maintain the exclusion of patient support by rhetorical arguments of the open-endedness of science to delay new findings of fact. This has

title: Chronic fatigue syndrome treatment
text: defined as either: death, life-threatening, hospitalisation, increased severe disability for at least 4 weeks duration, any episode of deliberate self-harm. Serious adverse reactions to the therapies were recorded in two (1%) of the 159 patients in the APT group, three (2%) of the 161 patients in the CBT group, 2 (1%) of the 160 patients in the GET group and two (1%) of the 160 patients in the SMC group. A subsequent paper examined the proportion of patients who could be classified as recovered after the trial. A patient was considered recovered if they obtained a specified threshold score on

title: Chronic fatigue syndrome
text: in many illnesses, but the unexplained fatigue and severity of functional impairment in CFS is comparatively rare. There is no cure, with treatment being symptomatic. No medications or procedures have been approved in the United States. Evidence suggests that cognitive behavioral therapy (CBT) and a gradual increase in activity suited to individual capacity can be beneficial in some cases. In a systematic review of exercise therapy, no evidence of serious adverse effects was found, however data was insufficient to form a conclusion. Some patient support groups have criticized the use of CBT and graded exercise therapy (GET). Tentative evidence supports

title: Fatigue
text: inhibited. Muscle strength testing can be used to determine the presence of a neuromuscular disease, but cannot determine its cause. Additional testing, such as electromyography, can provide diagnostic information, but information gained from muscle strength testing alone is not enough to diagnose most neuromuscular disorders. People with multiple sclerosis experience a form of overwhelming lassitude or tiredness that can occur at any time of the day, for any duration, and that does not necessarily recur in a recognizable pattern for any given patient, referred to as "neurological fatigue". Mental fatigue is a temporary inability to maintain optimal cognitive performance. The