NICE clinical guidelines
Issued: August 2007
CG53

Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): Diagnosis and management of CFS/ME in adults and children

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg53

Key priorities for implementation

General principles of care

  • Shared decision-making between the person with CFS/ME and healthcare professionals should take place during diagnosis and all phases of care. The healthcare professional should:

    • Acknowledge the reality and impact of the condition and the symptoms.

    • Provide information about the range of interventions and management strategies as detailed in this guideline (such as the benefits, risks and likely side effects).

    • Provide information on the possible causes, nature and course of CFS/ME.

    • Provide information on returning to work or education.

    • Take account of the person's age (particularly for children younger than 12 years), the severity of their CFS/ME, their preferences and experiences, and the outcome of previous treatment(s).

    • Offer information about local and national self-help groups and support groups for people with CFS/ME and their carers (see also the NHS Expert Patients Programme[2]).

  • Healthcare professionals should be aware that – like all people receiving care in the NHS – people with CFS/ME have the right to refuse or withdraw from any component of their care plan without this affecting other aspects of their care, or future choices about care.

  • To facilitate effective management of the condition, healthcare professionals should aim to establish a supportive and collaborative relationship with the person with CFS/ME and their carers. Engagement with the family is particularly important for children and young people, and for people with severe CFS/ME.

  • Healthcare professionals should provide diagnostic and therapeutic options to people with CFS/ME in ways that are suitable for the individual person. This may include providing domiciliary services (including specialist assessment) or using methods such as telephone or email.

Diagnosis and initial management

  • Advice on symptom management should not be delayed until a diagnosis is established. This advice should be tailored to the specific symptoms the person has and be aimed at minimising their impact on daily life and activities.

  • A diagnosis should be made after other possible diagnoses have been excluded and the symptoms have persisted for:

    • 4 months in an adult

    • 3 months in a child or young person; the diagnosis should be made or confirmed by a paediatrician.

  • Healthcare professionals should proactively advise about fitness for work and education, and recommend flexible adjustments or adaptations to work or studies to help people with CFS/ME to return to them when they are ready and fit enough. This may include, with the informed consent of the person with CFS/ME, liaising with employers, education providers and support services, such as:

    • occupational health services

    • disability services through Jobcentre Plus

    • schools, home education services and local education authorities

    • disability advisers in universities and colleges.

Specialist CFS/ME care

  • Any decision to refer a person to specialist CFS/ME care should be based on their needs, the type, duration, complexity and severity of their symptoms, and the presence of comorbidities. The decision should be made jointly by the person with CFS/ME and the healthcare professional.

  • An individualised, person-centred programme should be offered to people with CFS/ME. The objectives of the programme should be to:

    • sustain or gradually extend, if possible, the person's physical, emotional and cognitive capacity

    • manage the physical and emotional impact of their symptoms.

  • Cognitive behavioural therapy and/or graded exercise therapy should be offered to people with mild or moderate CFS/ME and provided to those who choose these approaches, because currently these are the interventions for which there is the clearest research evidence of benefit.