Chronic Fatigue Syndrome Deserves Its Own Guideline

According to the authors, chronic fatigue syndrome (CFS) should have its own guideline and “will not be dealt with any further in this article” (1). Indeed, this common complex disorder, which in Germany remains underdiagnosed and misdiagnosed (ca 250 000 in Germany) should have been given its own guideline long ago. This, however, does not exist—and for this reason the disorder could have been explicitly explained in the article “Fatigue as the Chief Complaint,” since paralyzing fatigue is one of the main symptoms in CFS. The article also refers to “a syndrome that has been defined in various ways, without any uniform etiology, and with varying diagnostic criteria.” But reliable criteria for the diagnosis of this complex neuroimmunological disorder exist (the Canadian consensus criteria). According to the current state of research, what it is definitely not is psychological, psychosomatic, or socially caused fatigue (more than 1800 studies in the past decade). This is, however, the implicit message of the article, in which a woolly comment on CFS is linked to declarations regarding primarily psychologically/psychosocially caused fatigue.

In the conclusion, the authors say that in patients “with an unremarkable history, physical examination, and basic laboratory test battery” organic disorders are highly unlikely. But is it logical, medically correct, and medically justifiable to conclude from one tiny unremarkable detail (basic laboratory tests) among thousands of laboratory variables: it can’t be anything bad? In CFS, these basic variables are normal—in difference to numerous other laboratory variables. This is also the case for long COVID and, for example, migraine—but in contrast to CFS, these are accepted as disorders and are naturally diagnosed on the basis of clinical criteria.

It is of the greatest importance to differentiate CFS from less severe disorders that are accompanied by fatigue with great clarity and objectivity as a severe physical disorder.