The Canadian Clinical Guidelines
Published in 2003, the Canadian clinical diagnostic criteria for myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) was developed by an expert medical consensus panel of working physicians, teaching faculty and world leaders in the research of ME/CFS.
It was assumed that following this medical milestone, a concerted effort would be underway to have these diagnostic criteria in wide usage so as to unravel the confusion which exists with present day diagnostic patterns. Indeed in Ireland, as elsewhere, most doctors don't even use published criteria for diagnosis, be it Fukuda, London, Oxford, or an alternate variation. Most doctors currently give a diagnosis of ME/CFS usually because a patient reports with fatigue and / or muscle pain and the doctor cannot find any test results to give a conclusive diagnosis. If you complain primarily of fatigue, you may be further referred to a neurologist or psychiatrist. If you complain primarily of muscle or joint pain, you will probably be referred to a rheumatologist, in which case you will be given a diagnosis of fibromyalgia, which adds to the already existing confusion. What needs to be done is for doctors to understand that there is a need for a diagnosis of ME or CFS to be given, not just because they cannot find anything else going wrong, but because the individual fulfils the pattern of a diagnosis of ME/CFS.
The basis for this diagnosis must lie with the Canadian Definition, because to use the Oxford or even Fukuda, simply allows a diagnosis of ME/CFS to be made for a wide variety of complaints. This is particularly important when it comes to treatment routes, particularly the advice to exercise. While exercise will be beneficial to a number of people diagnosed ME/CFS under the Oxford or Fukuda criteria, this is not the case when using the Canadian guidelines. If Post-Exertional Malaise is a core symptom, then exercise cannot be the remedy.
The history of the framing of ME/CFS criteria has been well documented. A defining moment for the future of ME sufferers probably occurred in a boardroom of the Centers for Disease Control in Atlanta Georgia in the late 1980s. Alarm bells had crept in because of the escalating numbers of people contracting an illness of unknown aetiology, but which closely resembled the criteria set out in the UK by Dr Melvin Ramsay and named Myalgic Encephalomyelitis.
In order to carry out research with the numbers they felt they needed, they framed a new set of criteria (Fukuda definition) and adopted the term Chronic Fatigue Syndrome. These new diagnostic criteria created case definitions that were so broad, so nondistinct, that it produced a diverse representation of many differing illnesses. This resulted in many patients whose symptoms could appear so different yet would all be diagnosed as CFS.
The problems posed by criteria such as Fukuda, which was not designed for clinical diagnosis, has resulted in a failure to separate sufferers of the neurological disease ME/CFS ICD-10 G93.3 away from those suffering from other illnesses in which `fatigue` is a factor (including psychiatric problems) and has caused much confusion amongst patients and doctors.
The UK group of psychiatrists let by Simon Wessely and Michael Sharpe framed the Oxford criteria which further downplayed physical symptoms, yet still used the term CFS, thus further marginalising ME patients. This dilemma persists to this day and is further exacerbated by the practice of medical schools and training colleges seeing fit to hold lectures with Wessely (psychiatric) school disciples giving their views on ME/CFS.
Information on the Canadian ME/CFS Clinical Case Definition, attached with a diagnostic tick chart has now been sent to over 2,300 General Practitioners in Ireland, along with the pledge to further dispatch a 16-page guidelines synopsis to interested doctors. This 16 page booklet, which has been compiled by a group of Australian Physicians, is a very useful publication and will prove very valuable for any doctor who takes the time out to read it. If your GP does not have a copy, a print can be obtained from the following link
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