Chronic Fatigue Syndrome / ME

Other

Overview

Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) is a complex, multi-system condition characterised by profound fatigue, post-exertional malaise (PEM), cognitive impairment, and sleep dysfunction that is not explained by other conditions. It frequently follows a viral trigger and significantly impairs daily function.

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Medically Managed — Refer Early

This condition is primarily medically managed. Osteopathic care may play a supportive role — refer early if suspected.

Typical Presentation

Site

Diffuse myalgia and arthralgia; no single localised region

Quality

Aching, heaviness, fatigue-pain overlap; worsens significantly after exertion

Intensity

Severe functional impact; highly variable day-to-day

Aggravating

Physical or cognitive exertion (PEM is hallmark — worsening 12–48hrs post-activity)

Relieving

Pacing, rest, energy management; avoid push-crash cycles

Associated

Unrefreshing sleep, brain fog, orthostatic intolerance, sensory sensitivities

⚠ Red Flags

  • •Unexplained weight loss or night sweats suggesting malignancy or systemic disease
  • •Progressive neurological deficit requiring CNS investigation
  • •Severe psychiatric comorbidity requiring urgent mental health input

⚡ Yellow Flags

  • •Push-crash cycles driven by poor pacing awareness
  • •Graded exercise therapy (GET) previously worsening symptoms — do not recommend GET for ME/CFS
  • •Social isolation and loss of role identity compounding disability
  • •High illness burden with limited support network

Referral Criteria

  • •GP referral for diagnostic workup and exclusion of other conditions
  • •ME/CFS specialist clinic or physician with experience in the condition
  • •Occupational therapy for pacing, energy management, and ADL support
  • •Note: Graded Exercise Therapy is NOT recommended for ME/CFS — flag this clearly in clinical notes