Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols

The Canadian Expert Consensus Panel Clinical Case Definition for ME/CFS by Dr Bruce Carruthers et al. The 2003 Canadian Expert Consensus Panel clinical case definition more accurately represents the true symptomatology and manifestations of the disease than all other current case definitions. As The M.E. Society of America explain:

The Canadian Expert Consensus Panel has published a medical milestone, the first clinical case definition for the disease known as myalgic encephalomyelitis/chronic fatigue syndrome. This definition is clearly a vast improvement over the CDC's 1994 Fukuda criteria, which led to misunderstanding in both research and treatment modalities by making "fatigue" a compulsory symptom but by downplaying or making optional the disease's hallmark of post-exertional sickness and other cardinal ME/CFS symptoms. In sharp contrast to the Fukuda criteria, this new clinical case definition makes it compulsory that in order to be diagnosed with ME/CFS, a patient must become symptomatically ill after exercise and must also have neurological, neurocognitive, neuroendocrine, dysautonomic, and immune manifestations. In short, symptoms other than fatigue must be present for a patient to meet the criteria. This case definition, which incorporates some of the current research on dysautonomia, cardiac, and immune problems, was published in the Journal of Chronic Fatigue Syndrome, Vol. 11 (1) 2003. ([Online]).

It is true however that along with many excellent features in these guidelines there are also some very serious weak points and drawbacks in the text (the treatment section is very weak and flawed and along with every definition of the illness written since 1988 when the ‘fatigue’ myth was created to obfuscate the true nature of the illness for political and financial gain these guidelines also unfortunately still use the medically inaccurate terminology of ‘fatigue’ for example).

Despite its imperfections however, the Canadian Guidelines remain overall vastly superior to all other definitions of the illness in existence. In contrast to the Oxford, Holmes and Fukuda (and other) recent definitions the Canadian Guidelines describes an illness that is recognisable as M.E. finally which makes these guidelines a vitally important new tool for M.E. specialists, researchers and patients around the world. M.E. is a distinct, recognisable entity that can be diagnosed relatively early in the course of the disease, providing the physician has some experience with the illness. The new Canadian Guidelines now also make diagnosis easier than ever before even for those with no experience with the illness.

In addition to the need for government funding for research into M.E. however, funding is also necessary to formulate a truly accurate case definition for M.E. (not 'ME/CFS'). One which is not tainted by the bogus concept of ‘fatigue’ or by psychological bias and which has been produced by true M.E. experts. Until that time however, the Canadian Guidelines are far superior to the many 'CFS' definitions and should be used to the exclusion of all others.

Read some excellent comments and critiques of the Guidelines online at:

• A review of the 2003 clinical case definition by Maryann Spurgin Ph.D.
• ME and CFS, the Definitions from the Committee for Justice and Recognition of M.E.
• A New and Simple Definition of Myalgic Encephalomyelitis and a New Simple Definition of Chronic Fatigue Syndrome & A Brief History of Myalgic Encephalomyelitis & An Irreverent History of Chronic Fatigue Syndrome  (an extract, PDF format) by Dr Byron Hyde M.D.

These texts are each essential reading for anyone with an interest in M.E.

For more information on this topic see: The Definitions of M.E.

For more on the various texts (and tests) which may be useful in diagnosing M.E. see: Testing for M.E.

See Smoke and Mirrors for a discussion of why the disease category of 'CFS' must be abandoned.

Availability of the Guidelines

• A good summary of the clinical criteria (and more information about the guidelines generally) is available online.
• A PDF document containing the diagnosis and research summary sections of the definition is also available for free online.
• Read Comments from the Canadian Guidelines on Cognitive Behavior Therapy (CBT) and Graded Exercise Therapy (GET)
• A summary of the entire document is also available in PDF format online.
• Printed copies of the full text are available from www.haworthpressinc.com