Authors' objectives:

The Minister of Health and Social Services asked AETMIS to review the state of the evidence on CFS. The assessment was expected to specifically address different medical aspects of CFS: epidemiology, etiology and pathophysiology, along with its clinical and therapeutic management options. The Minister also wanted to know about best practices for CFS management and the education/training needs of the health professionals responsible for applying them. Organizational issues surrounding optimal CFS management for patients in Québec and its associated costs were also of interest

Authors' recommendations: Chronic fatigue syndrome (CFS) is a complex and heterogeneous illness with often debilitating effects affecting an undetermined proportion of the Quebec population. This syndrome has been defined by diagnostic criteria recognized for research purposes and is also listed in the World Health Organization’s International Classification of Diseases (ICD-10).Current research has so far not been able to establish one single cause for this illness. Although post-infectious encephalomyelopathy is the most frequently cited cause, CFS seems attributable to multiple neurological, psychological, immunological and endocrine factors modulated by patients’ specific heredity and environmental stress. Diagnosing CFS is a process of exclusion. It depends on medical history and physical examination because no specific diagnostic laboratory or imaging tests exist. These tests serve mostly to exclude the presence of associated conditions, such as depression. Cognitive behaviour therapies (CBTs) and graded exercise programs or therapies (GEPs/GETs) seem to be effective and safe and are probably cost effective for alleviating CFS symptoms and improving patients’ quality of life in the short term. Some pharmacological therapies have shown promise; others are more controversial and sometimes harmful. Most of them provide only symptomatic relief or treat only comorbidities, such as depression. Different countries in Europe have structured care and services organized in the form of programs or service pathways to meet the physical and occupational rehabilitation needs of people with CFS. Other countries, like Australia, propose clinical practice guidelines and protocols to support primary-care management of CFS. Several health and social service professionals admitted their lack of knowledge about the syndrome and voiced some skepticism about its actual existence. They expressed concern over the lack of specific patient management resources and mentioned that they had little experience with using therapies recognized as effective, such as CBTs. The Quebec patients we met bemoaned the generalized lack of knowledge about the syndrome among health and social service professionals. They said that they needed the syndrome to be recognized as a genuine illness for them to be able to access rehabilitation services, psychotherapy,

Project Status: Completed

URL for project: http://www.aetmis.gouv.qc.ca/site/phpwcms_filestorage/0a40c05af60a3298d643636f2ec5848f.pdf

Year Published: 2010

URL for published report: http://www.aetmis.gouv.qc.ca/site/en_publications_2010.phtml

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Agence d'évaluation des technologies et des modes d'intervention en santé

Contact Address: 2021, avenue Union, Bureau 10.083,Montreal, Quebec H3A S29, Canada.Tel: +1 514 873 2563; Fax: +1 514 873 1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS)