Myalgic Encephalomyelitis / Chronic Fatigue Syndrome

Dr Nina Muirhead | Resource Author

"ME/CFS is one of the most fascinating and important diseases of our time. This module was first developed as a patient professional collaboration in 2020 when the Coronavirus pandemic began and there was already a ‘long Covid’ case example in the earlier version. Over the last three years, there have been tens of thousands of medical publications on long Covid and many highlighting the similarities with ME/CFS. Scientific understanding of post-viral disease and associated symptoms and syndromes is revolutionising how patients should be treated. It has become evident that at least a subset of patients with long Covid have symptoms, and likely underlying pathophysiology, which significantly overlaps with those who have ME/CFS due to other causes. This updated module has incorporated some of these relevant biomedical updates.

Both ME/CFS and long COVID may present with a plethora of symptoms and taking a good history is paramount, particularly whilst we await more accurate and readily available clinical biomarkers.

ME/CFS is no longer a diagnosis of exclusion and patients should be reviewed regularly and new symptoms investigated as they would normally. ME/CFS, long Covid, Lyme disease, endometriosis, fibromyalgia, POTS (postural tachycardia syndrome), MCAS (mast cell activation syndrome), and other autoimmune and connective tissue diseases need to be diagnosed and coded. The economic and social impact of chronic disease affecting often young, otherwise productive individuals is a burden that every one of us will bear and it is the responsibility of all healthcare professionals to update their own knowledge to be able to offer early and accurate diagnosis and support.

Post-exertional malaise (PEM), characterised by disease and symptom exacerbation following slightly increased physical, mental, and emotional demand, is a cardinal feature which must be identified and managed with clinical advice to pace. Exercise is commonly considered a ‘cure-all’ but has the potential to cause harm and PEM is a red flag that all healthcare professionals should identify from the clinical history. Do not advise patients to ignore and push through their symptoms. Often sufferers do not realise that trivial or previously tolerated levels of exertion can cause PEM.

One of the most common mistakes clinicians make is underestimating ME/CFS. Evidence shows there is a huge impact on the quality of life of patients and their family members. Patients have been ignored and stigmatised and those who are most severely impacted are least able to access the healthcare that they need. This is an evolving area of medicine, so any feedback or updates are welcome. I sincerely thank you for taking the time to learn about ME/CFS."

Dr Nina Muirhead BA(oxon) BMBCh(oxon) MRCS DOHNS MEd PGDipDerm

Dr Muirhead is also associated with or alumni of: Oxford University, Open University, Cardiff University, Buckinghamshire Healthcare NHS Trust, the Royal College of Surgeons and the Royal College of Physicians.