Fatigue Tool Kit

HKC Bottom Line

• Fatigue is one of the most common presentations in primary care, being the main complaint of 5-10% of patients and an important subsidiary symptom in a further 5-10%. There is an opportunity for mismatch, as we clinicians often see it as a non-specific symptom whereas the patient can find it very disabling. Rule out common causes (thyroid, insomnia, diabetes, depression, anxiety, and chronic disease) and test accordingly. If negative, consider chronic fatigue syndrome, empathize, and continue active management. Behavioral therapy and graded activity seem to help most.

Disease Overview

  General

• BMJ Clinical Review. ABC of Psychological Medicine: Fatigue (Aug 2002).
  
  
• NHS Center for Reviews and Dissemination. Effective Health Care Bulletin: Interventions for the Management of CFS/ME (2002). A bulletin summarizing the effectiveness of interventions for the treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis
  
  
• American Family Physician. Chronic Fatigue Syndrome: Evaluation and Treatment (Mar 2002).

  Diagnosis

• National Chronic Fatigue Syndrome and Fibromyalgia Association. A Guide for Physicians When Considering a Diagnosis of CFS in Children (2001).

   Addressing the Unknown (Q & A)

• ICES Informed. Chronic Fatigue Syndrome: Many Questions, Some Answers (Sept 1999).
  Good overview of common questions encountered in practice.
  
  
• Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America. Q&A's (2003).
  Good overview of common questions encountered in practice.

Management and Prescribing Advice

• BMJ Clinical Review. ABC of Psychological Medicine: Functional Somatic Symptoms and Syndromes (Aug 2002).
  
  
• Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America.
  Chronic Fatigue Syndrome: Treatment Overview (2003).
  Provides "tips" and "considerations" when trying to manage CFS.
  
  
• Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America. Treatment (2003).
  Superficial information and practical tips on treatment options for the possible symptoms associated with CFS.

Algorithms

• American Family Physician. Chronic Fatigue Syndrome: Evaluation and Treatment (Mar 2002).
  
  
• Clinical Practice Guidelines. Medically Unexplained Symptoms Algorithm-Fatigue and Chronic Pain (Feb 2002).

Guidelines

• EMJA. Clinical Practice Guidelines on the Evaluation of Prolonged Fatigue and the Diagnosis and Management of Chronic Fatigue Syndrome (1997).

Patient Resources

  Printable Patient Resources

• American Family Physician. Chronic Fatigue Syndrome: How to Help Yourself.
  A quick 1-page information tool for your patients.
  
  
• National Institute of Allergy and Infectious Disease. Chronic Fatigue Syndrome Fact Sheet.
  A 4 page print out that provides your patient with a comprehensive overview of CFS.
  
  
• Kids Health for Parents. Chronic Fatigue Syndrome.

  Web-Based Resources

• Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America. About CFIDS.
  A comprehensive website for your web-savvy patients.
  
  
• Center for Disease Control. Chronic Fatigue Syndrome Information.
  Extensive information for your more educated patient.
  
  
• Toronto Public Library. Overview and Suggestions for Resources (2002).