Drug Topics - January 28, 2008 - (Page 19) 19 CFS can affect people of all ages, including children. People aged 40-59 are more frequently diagnosed with CFS at this time. People of all income levels are diagnosed with CFS. Some research suggests that it may be more common in lower-income individuals. A specific genetic link has not been identified; however, CFS has sometimes occurred within the same family. GOAL To provide pharmacists with an understanding of chronic fatigue syndrome (CFS) and knowledge to help them counsel patients with this disorder. CREDIT This lesson provides two hours of CE credit and requires a passing grade of 70%.* Signs and symptoms The signs and symptoms of CFS can be misleading. The syndrome can be similar to a viral infection or the flu; however, unlike these infections, CFS can last for years. The symptoms of this condition may also occur in an intermittent pattern, creating an even greater diagnostic challenge for the healthcare provider. The primary symptom for patients is an unexplained, debilitating fatigue that has existed for greater than six months and has not been alleviated by rest. Additional symptoms the patient may complain of may include, but not be limited to: impaired memory or concentration, muscle or joint pain not associated with redness or swelling, sore throat, painful or mildly enlarged lymph nodes, new headaches, and sleep disturbances. CFS patients may also present with multiple other symptoms that are not part of the current diagnostic criteria for this condition. They include: abdominal pain; allergies or sensitivities to foods, alcohol, odors, chemicals, medications, or noise; bloating; chest pain; chronic cough; diarrhea; dizziness; balance problems or fainting; dry mouth; earache; irregular heartbeat; jaw pain; morning stiffness; nausea; chills and night sweats; psychological problems, such as depression, irritability, anxiety disorders, and panic attacks; shortness of breath; tingling sensations; visual disturbances, such as blurring, sensitivity to light, eye pain, and dry eyes; and weight loss or gain. The significant variation in symptoms is often what has created challenges for the healthcare provider in diagnosing CFS. Diagnostic criteria The Centers for Disease Control & Prevention brought together a scientific group called the International Chronic Fatigue Syndrome Study Group. This group developed a standard method for diagnosing CFS. (See Table 1.) It is important for pharmacists to be familiar with the diagnostic criteria for CFS as pharmacists may play a key role in not only evaluating a patient’s medication therapy to determine if any signs and symptoms of this condition could be attributed to medications, but they may also encounter these patients who may present at the pharmacy seeking relief of the symptoms of CFS. The primary trait leading to a diagnosis of CFS includes OBJECTIVES Upon completion of this article, the pharmacist and technician should be able to: Define and describe CFS. List the risk factors for CFS. Differentiate CFS from other conditions with similar symptoms. Review pharmacologic and non-pharmacologic treatment entities that may be helpful in treating patients with CFS. Counsel patients with CFS so they can better cope with the illness. *To receive credit you must score 70% or higher on the quiz and complete the evaluation. Upon successful completion, the University of Florida College of Pharmacy will mail Statements of Credit for written quizzes within 10 working days. Participants completing the program on-line may print a Statement of Credit after successfully completing the program. the patient reporting severe, unexplained persistent or relapsing fatigue of at least six months’ duration. The chronic fatigue has both mental and physical conditions that result in a significant reduction in previous daily activities, including work, household, recreational, or educational activities. Even with significant rest, the CFS patient will not be relieved of the symptoms of the condition. In addition to the criteria of persistent fatigue lasting six months or longer, four or more other symptoms must be present. These include: loss of memory or concentration, sore throat, painful and mildly enlarged lymph nodes, unexplained muscle soreness, joint pain without swelling or redness, headache, sleep disturbance, and postexertional malaise. It is important to mention that there is a diagnostic difference between prolonged fatigue and chronic fatigue. The definition of prolonged fatigue includes a self-reported, persistent fatigue of one month or longer. Chronic fatigue is also a self-reported fatigue; however, the difference is that CFS patients will express a duration of persistent or relapsing fatigue for six months or longer.
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