Myalgic Encephalomyelitis and Chronic Fatigue Syndrome

Overview

Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) is a complex and debilitating condition, characterised by profound fatigue following exertion (not relieved by sleep or rest), unrefreshing sleep and cognitive impairment. Secondary symptoms may include gastrointestinal disorders, muscle and joint pain and immune impairments. Post exertional malaise (PEM) is suggested as a cardinal feature of ME/CFS.^{1, 2}
The aetiology of ME/CFS is not established, although many hypotheses exist.³ Diagnosis is also a challenge in the absence of a diagnostic test and lack of a universally accepted case definition among researchers and clinicians.⁴ Diagnosis currently relies on elimination of other similar disease patterns and self-reported symptom based criteria. Symptoms are varied and diverse patient experiences make ME/CFS diagnosis and treatment challenging.⁵ 

ME/CFS Advisory Committee Report to the NHMRC CEO

The ME/CFS Advisory Committee Report was finalised in April 2019. This report advises the NHMRC CEO on the current needs for research and clinical guidance for ME/CFS in Australia. A draft of the ME/CFS Report was released for public consultation for a period of 60 days, between 21 December 2018 and 18 February 2019. A summary  of the number of responses received for public consultation is provided in the table below. 

• CEO Response - Open Letter to stakeholders 
• ME/CFS Advisory Committee Report to NHMRC Chief Executive Officer 
• Public consultation submissions

Summary of public consultation submissions received 

*30 submissions were not considered due to being incomplete, duplicate or portal test
**122 submissions were not published due to: 

• submitter not giving consent for publication (113)
• submission provided is an incompatible/unpublishable format (9) 

ME/CFS funding announcements

On 27 March 2019, the Australian Government announced the allocation of $3 million for an NHMRC Targeted Call for Research (TCR) to better understand the causes and improve the diagnosis of ME/CFS. The call opened on 23 October 2019 and closes 29 January 2020. Further information is available here. Outcomes of this TCR can be downloaded below.

This is in addition to the Australian Government’s funding of a grant through the Medical Research Future Fund (Targeted Health System and Community Organisation Research Program) to conduct a health economics study of the impacts and costs associated with ME/CFS. Outcomes of this grant were announced on 20 September 2019. More information about the announcement is available here. 

Resources

Information for Clinicians

Frontiers in Paediatrics - Initiating Care of a Patient With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) (2019) 

British Medical Journal - Best Practice guideline – Beyond ME/CFS: redefining an Illness (2017)

Frontiers in Paediatrics - ME/CFS Diagnosis and Management in Young People: A Primer (2017) 
(A note for clinicians: this article contains a Clinical Diagnostic Worksheet for use at initial and subsequent consultations) 

Canadian Medical Association – Toward optimised practice –Identification and symptom management of ME/CFS - Clinical Practice Guidelines (2016) 
(A note for clinicians: this article contains a ME/CFS Symptom Checklist) - See Downloads. 

Institute of Medicine – Beyond ME/CFS Redefining an Illness: Report guide for Clinicians (2015) (A note for clinicians: Questionnaires and tools for assessing symptoms of ME/CFS are provided on pages 13-14.)   

ME International Consensus Primer for Medical Practitioners: International Consensus Panel 2012 - See Downloads 

International Association for CFS/ME (IACFSME) Chronic Fatigue Syndrome /Myalgic Encephalomyelitis – Primer for Clinical practitioners (2014 ed)

A patient centred approach - Royal Australian College of General Practitioners (2013) 

ME/CFS fact sheet – Better Health Channel a resource for GPs - See Downloads 

Treating Chronic Fatigue Syndrome - Royal Australian College of General Practitioners (2011) - See Downloads 

ME/CFS guidelines: Management Guidelines for General practitioners – Government of South Australia (2004) (A note for clinicians: this article contains a ME/CFS Symptom Checklist) - See Downloads 

Royal Australasian College of Physicians (RACP) Chronic Fatigue Syndrome Clinical practice guidelines (2002)

Disclaimer: The findings and conclusions in these documents are those of the authors and do not represent the official position of the National Health and Medical Research Council. The resources are listed by year of publication and as such do not imply any NHMRC preference or priority. 

Information for ME/CFS Patients and Carers

Bridges and Pathways - http://bridgesandpathways.org.au/index.php/mecfs/ 

Emerge Australia - https://emerge.org.au/ 

ME/CFS Australia (SA) http://www.sacfs.asn.au/

ME/CFS Australia  https://mecfs.org.au/about-us/related-organisations

U.S Center for Disease control (CDC) ME/CFS https://www.cdc.gov/me-cfs/

Disclaimer: The findings and conclusions in these documents are those of the authors and do not represent the official position of the National Health and Medical Research Council.  The resources are listed alphabetically and as such do not imply any NHMRC preference or priority. 

Contact

For further information please contact NHMRC at ME_CFS@nhmrc.gov.au

References

1. Institute of Medicine (IOM), 2015. Beyond Myalgic Encephalomyelitis/Chronic fatigue Syndrome: Redefining an illness. Washington, DC. The National Academies Press. Available from: https://www.ncbi.nlm.nih.gov/books/NBK274235/
2. Carruthers, BM, Van de Sande, MI, De Meirleir, KL et al, 2011. ‘Myalgic encephalomyelitis: International consensus criteria,’ Journal of Internal Medicine, vol. 270, is. 4, pp. 327-338. 
3. Monro, JA & Puri, BK, 2018. ‘A Molecular Neurobiological Approach to understanding the aetiology of chronic fatigue syndrome (Myalgic Encephalomyelitis or Systemic exertion intolerance disease) with treatment implications,’ Molecular Neurobiology. https://doi.org/10.1007/s12035-018-0928-9
4. Johnston, S, Staines, D, Marshall-Gradisnik, S, 2016. Epidemiological characteristics of chronic fatigue syndrome/Myalgic encephalomyelitis in Australian patients,’ Clinical Epidemiology, vol. 8 pp. 97-107. 
5. Baraniuk, JN, 2017. ‘Chronic Fatigue Syndrome: BMJ Best Practice guideline.’ British Medical Journal, Accessed May 2018. https://bestpractice.bmj.com/topics/en-gb/277