What’s in a Name? Chronic Fatigue Syndrome Gets a Makeover

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


In February of 2015, the Institute of Medicine (IOM) put forth a proposal to change the name and the diagnostic criteria for chronic fatigue syndrome (CFS). People who suffer from this condition are often made to feel that their symptoms are psychological or a figment of their imagination. Patients may see multiple practitioners in an attempt to find symptom relief for their CFS.

The name “chronic fatigue syndrome” was coined by the Centers for Disease Control in 1988. The Europeans prefer to call this condition myalgic encephalomyelitis (ME) which focuses on central nervous system (CNS) inflammation with muscle pain. Many experts now call this condition ME/CFS.

Since CNS inflammation and muscle pain are not universal components of ME/CFS, an IOM panel undertook the task of defining the major symptoms suffered by people with CFS. They concluded that the most prominent and universal symptom of CFS is a lingering depletion of energy after minimal physical and/or cognitive exertion. The panel recommended that CFS be renamed systemic exertion intolerance disease (SEID) or post-exertional malaise (PEM) for short.

The panel proposed the following diagnostic criteria:

  • Extreme fatigue lasting more than six months
  • Post-exertional malaise
  • Unrefreshing sleep
  • Either cognitive impairment or orthostatic intolerance (symptoms made worse by standing and relieved when reclining)

Wisconsin researchers recently published an interesting study in this area. Thirteen CFS patients and 11 healthy controls exercised to their maximal capacity. Researchers obtained blood samples and administered symptom questionnaires before and up to 72 hours after exercise. They measured gene expression for metabolite, cortisol, adrenaline and immune system receptors. Individuals with CFS had a significant increase in the number of cortisol and adrenaline receptors up to 72 hours after exercising compared to control subjects.

Could low cortisol levels be a factor in CFS? A review of multiple scientific studies found significantly low cortisol levels in people with CFS. Hydrocortisone supplementation may be an important piece of the recovery puzzle for people with chronic fatigue.

  • Tuller D. Chronic Fatigue Syndrome Gets a New Name. The New York Times. https://well.blogs.nytimes.com/2015/02/10/chronic-fatigue-syndrome-gets-a-new-name: February 10, 2015.
  • “Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Key Facts” by Institute of Medicine of the National Academies.
  • Meyer JD, et al. Post-exertion malaise in chronic fatigue syndrome: symptoms and gene expression. Fatigue: Biomedicine, Health & Behavior. 2013; 1(4): 190-209.
  • Lineke M, et al. Meta-analysis and meta-regression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders. Biol Psychol. 2011; 87: 183-194.