IOM releases report on myalgic encephalomyelitis/chronic fatigue syndrome

The Institute of Medicine (IOM) released a report recently calling for improved diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and recommended that it be renamed “systemic exertion intolerance disease.”

The report, which was developed by an expert committee, outlined new diagnostic criteria for ME/CFS, including 3 core symptoms and at least 1 of 2 additional manifestations. The 3 core symptoms are:

• substantial reduction or impairment in the ability to engage in pre-illness levels of activities that persists for more than 6 months and is accompanied by fatigue, often profound, of new or definite onset, not the result of ongoing excessive exertion and not substantially alleviated by rest;
• worsening of patients' symptoms after any type of exertion, such as physical, cognitive, or emotional stress, known as post-exertional malaise; and
• unrefreshing sleep.

The 2 additional manifestations are cognitive impairment and orthostatic intolerance.

The committee recommended that the U.S. Department of Health and Human Services develop a toolkit for screening and diagnosing patients with ME/CFS in primary care practices, emergency departments, and mental health clinics. It recommended the name change to “systemic exertion intolerance disease” because the term “chronic fatigue syndrome” is misunderstood and easily dismissed. It also stated that the term “myalgic encephalomyelitis” is not accurate because myalgia is not a core symptom and evidence of brain inflammation is inconclusive. The committee also called urgently for additional research and recommended that the new diagnostic criteria be reexamined in 5 years or sooner if new evidence emerges.

A copy of the IOM's full report, which was published Feb. 10, is available free of charge online (registration required).