Pooling was not appropriate for CFS.In studies with control groups of patients without the symptom of tiredness , prevalence of somatic disease was identical to those complaining of tiredness .
Depression , however , was more frequent among those with tiredness .
Conclusions Serious somatic disease is rare in patients complaining of tiredness .
Since prevalence is similar in patients without tiredness , the association may not be causal .
Background Tiredness is one of the most frequent complaints in primary care .
Although often self-limiting and frequently associated with psychosocial stress , patients but also their physicians are often uncertain regarding a serious cause and appropriate diagnostic work-up .
We conducted a systematic review and meta- analysis of studies reporting on differential diagnosis of fatigue in primary care .
Chief complaint of fatigue: a prospective study.
The Dartmouth COOP Project , a primary care research network , conducted a prospect i ve study of patients presenting to 28 primary care practice s with a chief complaint of fatigue . Data were gathered on fatigue status , associated systems , health status , and origin of fatigue .  Fatigue patients were demographically similar to nonfatigue patients but had significantly worse physical and mental health at study intake . Sixty-three percent of physicians and 52 % of patients rated fatigue origin as primarily physical ( gamma = 0.48 , P less than .05 ) , but in 41 % of cases , physicians indicated there was substantial interaction between physical and psychological factors . Only two factors -- depression and anxiety -- separated fatigue of physical origin from fatigue of psychological origin . Clinicians must thoughtfully evaluate fatigue 's often multiple causes and communicate their underst and ing of those causes to the patient to gain support for a reasonable treatment regimen
Pooling was not appropriate for CFS.In studies with control groups of patients without the symptom of tiredness , prevalence of somatic disease was identical to those complaining of tiredness .
Depression , however , was more frequent among those with tiredness .
Conclusions Serious somatic disease is rare in patients complaining of tiredness .
Since prevalence is similar in patients without tiredness , the association may not be causal .
Background Tiredness is one of the most frequent complaints in primary care .
Although often self-limiting and frequently associated with psychosocial stress , patients but also their physicians are often uncertain regarding a serious cause and appropriate diagnostic work-up .
We conducted a systematic review and meta- analysis of studies reporting on differential diagnosis of fatigue in primary care .