Chronic Fatigue Syndrome: Medical History

Medical history (history of illness) represents an important component in the diagnosis of chronic fatigue syndrome (CFS; systemic exertion intolerance disorder (SEID)). Family history

• What is the general health status of your family members?

Social history

• What is your profession?
• Are you exposed to harmful working substances in your profession?
• Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

These symptoms suddenly appear in a previously active person

• Fatigue
• Early exhaustibility
• Concentration problems
• Fatigue

Associated symptoms

• Allergies (55%)
• Abdominal pain (40%)
• Pressure painful lymph nodes (80%)
• Exanthema (skin rash) (10%)
• Joint pain (75%)
• Weight loss (20%)
• Weight gain (5%)
• Sore throat (85%)
• Headache (in 90% of patients)
• Moderate fever (75%)
• Muscle pain (80%)
• Night sweats (5%)
• Mental problems (65%)
• Sleep disorders (70%)
• Tachycardia (increased pulse) > 100 beats per minute (10%).
• Chest pain (chest pain) (5%)* .

Vegetative anamnesis incl. nutritional anamnesis.

• Has your appetite changed?
• Has your body weight changed unintentionally?
• Do you suffer from sleep disorders?
• Do you use drugs? If yes, which drugs (heroin, opiates resp. Opioids (alfentanil, apomorphine, buprenorphine, codeine, dihydrocodeine, fentanyl, hydromorphone, loperamide, morphine, methadone, nalbuphine, naloxone, naltrexone, oxycodone, pentazocine, pethidine, piritramide, remifentanil, sufentanil, tapentadol, tilidine, tramadol)) and how often per day or per week?

Self history including medication history.

• Pre-existing conditions (infectious diseases, immunodeficiencies).
• Operations
• Allergies
• Environmental history (lead, cadmium, ozone, amalgam, mercury).
• Medication history (see below).

Diagnosis is made using the CDC criteria for chronic fatigue syndrome (CFS)

A case with chronic fatigue syndrome is defined by:

• A clinically confirmed, unexplained, persistent, or recurrent fatigue that is recent or known to have first manifested, is not the result of current physical exertion, does not improve with rest, and results in a substantial reduction in occupational, educational, social, or personal activities; and
• Four or more of the following complaints that persist or recur for at least six months and do not precede fatigue:
  • A self-observed deterioration in memory or concentration.
  • Sore throat
  • Painful cervical or axillary lymph nodes
  • Myalgia (muscle pain)
  • Polyarthralgia (pain in multiple joints) without redness or swelling.
  • Headache (cephalgia) of new pattern or intensity.
  • Non-restorative sleep (insomnia)
  • Feeling sick for at least 24 hours after physical exertion.
• Abdominal/chest pain*
• Moderate fever, night sweats

Medication history

• Alpha-2 agonist (tizanidine).
• Alpha-sympathomimetics (alfuzosin, doxazosin, oxymetazoline, tamsulosin, terazosin).
• Alpha-sympatholytics (phenoxybenzamine).
• Analgesics
  • Coxibe (celecoxib, parecoxib)
  • Opioids (alfentanil, buprenorphine, dextropoxyphene, hydromorphone, levomethadone, meptazinol, morphine, nalbuphine, oxycodone, pentazocine, pethidine, piritramide, remifentanil, sufentanil, tilidine, tramadol)
• Anthelmintics (albendazole, diethylcarbamazine, mebendazole, niclosamide).
• Antiarrhythmics
  • Class Ic antiarrhythmics (flecainide, propafenone).
  • Cardiac glycosides (ß-acetyldigoxin, ß-methyldigoxin, digoxin, digitoxin).
• Antibiotics
  • Macrolides (azithromycin, clarithromycin, erythromycin).
  • Steroid antibiotics (fusidic acid).
• Antidepressants
  • Noradrenergic and specific serotonergic antidepressants (NaSSA) – mirtazapine.
  • Selective norepinephrine reuptake inhibitors (NARI) – reboxetine, viloxazine.
  • Selective serotonin–norepinephrine reuptake inhibitors (SSNRIs) – duloxetine, venlafaxine.
  • Selective serotonin reuptake inhibitors (SSRI) – trazodone
  • Tetracyclic antidepressants (maprotiline, mianserine).
  • Tricyclic antidepressants (amitriptyline, amitriptyline oxide, clomipramine, desipramine, doxepin, imipramine, opipramol, nortriptyline, trimipramine).
• Antiemetics (scopolamine, dimenhydrinate, domperidone, metoclopramide (MCP)).
• Antiepileptic drugs (carbamazepine, clonazepam, gabapentin, oxcarbazepine, phenytoin, phenobarbital, pregabalin).
• Antihistamines (azelastine, cetirizine, clemastine, desloratardine, dimenhydrinate, dimetindene, diphenhydramine, ketotifen, loratadine, meclozine, promethazine, terfenadine).
• Antihypertensives (methyldopa).
• Antimalarials (artemether, dihydroartemisinin, lumefantrine).
• Antiparkinsonian agents (amantadine).
• Antiphlogistics (rifaximin)
• Antipsychotics (neuroleptics).
  • Conventional (Classical) antipsychotics (neuroleptics).
    • Butyrophenones – haloperidol, melperone.
    • Tricyclic neuroleptics – phenothiazines (fluphenazine).
  • Atypical antipsychotics (neuroleptics) – dopamine receptor antagonist (amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone, zotepine).
• Antivertiginosa (dimenhydrinate).
• Antitussives
  • Morphine derivatives (codeine, dihydrocodeine, hydrocodeine, dextromethorphan).
  • Non-opioid antitussives (levodropropizine, pentoxyverine).
• Anxiolytics (hydroxyzine).
• Α2-agonists (apraclonidine, brimonidine, clonidine).
• Beta-blockers, local (betaxolol, timolol).
• Beta-blockers, systemic
  • Nonselective beta-blockers (e.g., carvedilol, pindolol, propranolol, soltalol).
  • Selective beta blockers (e.g., atenolol, acebutolol, betaxolol, bisoprolol, celiprolol, nebivolol, metoprolol).
• Cannabinoids – cannabidiol (CBD), dronabinol (trans-delta-9-tetrahydrocannabinol, THC), nabilone, nabiximols.
• Carboanhydrase inhibitors, systemic (acetazolamide, dichlorophenamide, methazolamide).
• Dopamine agonists (prolactin inhibitors) (bromocriptine, lisuride).
• Dopamine antagonists (domperidone, metoclopramide (MCP))
• EGFR tyrosine kinase inhibitor (lapatinib).
• Hormones
  • Antiandrogens (cyproterone acetate)
  • Progestogens (dydrogesterone, progesterone; chlormadinone acetate, cyproterone acetate, desogestrel, dienogest, drospirenone, gestodene, levonorgestrel, norethisterone, norgestimate, nomegestrol).
  • Prolactin inhibitors (bromocriptine, cabergoline, lisuride, metergoline, quinagolide).
• Hypnotics/sedatives
  • Benzodiazepines (diazepam, lorazepam, midazolam, temazepam).
  • Clomethiazole
• Immunotherapeutics (mitoxantrone).
• Monoclonal antibodies (nivolumab, trastuzumab).
• Muscle relaxants (tetrazepam).
• Neuroleptics (melperone, olanzapine, sulpiride).
  • Atypical neuroleptics – aripiprazole, olanzapine, quetiapine.
  • Butyrophenones – haloperidol
  • Phenothiazines – Fluphenazine
• Neurokinin antagonists (aprepitant, fosaprepitant).
• Nicotinic agonist (varenicline).
• NMDA (n-methyl-D-aspartate) receptor antagonist (memantine).
• Lithium
• Phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil).
• Proton pump inhibitors (proton pump inhibitors, PPI; acid blockers) – esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole.
• Phytotherapeutics (valerian, St. John’s wort, passionflower).
• Sedatives
  • Benzodiazepines (alprazolam bentazepam, bromazepam, brotizolam, clobazam, clonazepam, clorazepate, clotiazepam, diazepam, etizolam, flunitrazepam, flurazepam, loprazolam, Lorazepam, Lormetazepam, Medazepam, Nitrazepam, Nordazepam, Oxazepam, Phenazepam, Prazepam, Temazepam, Tetrazepam* , Triazolam) [* Suspension of prescriptions since August 2013 due to. Serious skin reactions such as Stevens-Johnson syndrome or erythema multiforme]
• Spasmolytics (tolterodine,trospium chloride).
• Tyrosine kinase inhibitors (TKi)/angiogenesis inhibitors (pazopanib, sorafenib, sunitinib, vandetanib).
• Antivirals
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) – efavirenz, rilpivirine.
  • NS5A inhibitors (daclatasvir, ledipasvi, ombitasvir
  • Nucleos(t)idic polymerase (NS5B) inhibitors (sofosbuvir).
  • Protease inhibitors (paritaprevir).
• Cytostatic drugs (methotrexate, MTX).

* If this question has been answered with “Yes”, an immediate visit to the doctor is required! (Information without guarantee)