The Canadian Guidelines

Resource: Curruthers, B & van de Sande, M (2005) 'Canadian ME/CFS Clinical Case Definition and Guidelines for Medical Practitioners (Overview)', Carruthers and van de Sande, Canada.

This document, often referred to as the 'Canadian Guidelines', is the internationally accepted standard for the diagnosis of ME/CFS. It includes:

How to make an accurate diagnosis; Symptoms and effects upon the body; Clinical evaluation; Symptom management and treatment; Symptom severity check list; Sleep and pain profile;Assessing occupational disability; andTests for abnormalities.

Download the Canadian Guidelines (Overview)

Download the Canadian Guidelines (Full Document)

Carruthers, B; Kumar Jain, A; De Meirleir, K; Peterson, D; Klimas, N; Lerner, M; Bested, A; Flor-Henry, P; Joshi, P; Powles, P; Sherkey, J; and van de Sande, M (2003) 'Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical case working definition, diagnostic and treatment guidelines, A consensus document', Journal of Chronic Fatigue Syndrome, vol. 11, no. 1, pp. 7 - 115, Haworth Medical Press Inc.

Paediatric Diagnosis

Jason, L (2006) 'A Paediatric Case Definition of ME/CFS', Journal of Chronic Fatigue Syndrome, vol. 13, no. 2/3.

Differentiation between ME and CFS

Hyde, B (2009) 'Missed Diagnosis', Lulu.Com

Chapter 3, entitled 'Complexities of Diagnosis' by Byron Hyde in The Handbook of Chronic Fatigue Syndrome (2003) J, Leonard; P, Fennell; R Taylor, published by John Wiley and Sons Inc. You can download a copy here.

Differentiation between ME/CFS, depression and other psychiatric conditions

Stein, E (2005) 'Clinical Guidelines for Psychiatrists: Assessment and Treatment of Patients with ME/CFS'.

Stein, E (2009) Beyond tired: Helping patients cope with chronic fatigue syndrome, Pharmacy Practice, Dec/Jan 2009, pp. 14-21.

It is useful for GPs and other medical practitioners to measure the level of activity and ability of patients with ME/CFS to function with a simple instrument on every visit - the ME/CFS (or CFIDS) Disability Scale. The ME/CFS Disability Scale assists in documenting improvements or otherwise in the condition and the effects of medications, as well as provding a useful marker for long-term changes. It may also serve as a key reference should you need to write a medical history or supporting letter for disability benefit claims.

In marking the score of patients on the scale, it is important to document as accurately as possible the severity of symptoms, the degree of activity impairment with both activity and rest, and the functional ability regarding full time work. The principle behind the ME/CFS Disability Scale is that the severity of symptoms is related to exertion - physical and mental.

The concept that severity of symptoms is related to exertion is not one necessarily understood by all doctors, Centrelink representatives, insurance companies and employers. As Dr. Bell remarks in his book, these people are more likely to subscribe to the understanding that 'when you are sick, you're sick', not 'when you work, you're sick'.

A copy of the scale is available on the website of the CFIDS Association of America, here.

Adapted from Bell, D S (1994) 'The doctors guide to chronic fatigue syndrome: Understanding, treating and living with CFIDS', Addison-Wesley, USA. (Page 123).