Login

Chronic Fatigue/Myalgic Encephalomyelitis

Cornwall and Isles of Scilly Adult and Children’s Specialist Chronic fatigue/Myalgic Encephalomyelitis Service
 
Please note: 

We do not accept referrals for Benefits applications - refer to DIAL@disabilitycornwall.org.uk  0173679500

Or referrals for chronic widespread pain in absence of fatigue or other symptoms.

Or equipment only – consider patient self -referral to 0300 1234131

Patients 16 and under must be under the care of a Paediatrician.

 
This service
 
  • Consider referral  if all the following criteria are met:
  • Patient registered with a GP in Cornwall & IOS area.
  • Age > 16 to this service
  • If <16  refer  to paediatrician first. RCHT or Deffiford as appropriate.
  • History and examination and investigations don’t suggest an alternative differential diagnosis
  • Symptoms are limiting the activities of daily living/education/work significantly
  • Symptoms have existed for 4 months age over 16 OR 3 months in under 16 OR  re-occurrence of life altering symptoms in previously known and diagnosed patient
  • All 4 major and at least one minor criteria below satisfied:
 
MAJOR
  • FATIGUE WITH ALL 4 OF THE FOLLOWING FEATURES:
  • OF NEW OR HAD A SPECIFIC ONSET  
  • PERSISTENT AND/OR RECURRENT
  • UNEXPLAINED BY OTHER CONDITIONS
  • HAS RESULTED IN A SUBSTANTIAL REDUCTION IN ACTIVITY LEVEL CHARACTERISED BY POST-EXERTIONAL MALAISE AND/OR FATIGUE (TYPICALLY DELAYED, FOR EXAMPLE BY 24 HOURS, WITH SLOW RECOVERY OVER SEVERAL DAYS OR LONGER)
MINOR
 
  • Difficulty with sleeping, such as insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep–wake cycle
  • Muscle and/or joint pain that is multi-site and without evidence of inflammation
  • Headaches
  • Painful lymph nodes 
  • Sore throat
  • Cognitive dysfunction, such as difficulty thinking, inability to concentrate, impairment of short-term memory, and difficulties with word-finding, planning/organising thoughts and information processing
  • Physical or mental exertion makes symptoms worse
  • General malaise or ‘flu-like’ symptoms
  • Dizziness and/or nausea
  • Palpitations in the absence of identified cardiac pathology.
  • Sensitivities to light, noise, motion, foods.

Primary care management prior to referral:
  • Mediation management for nausea and pain
  • Sleep hygiene measures: discourage daytime sleeping and naps
  • Encourage a good daily routine with frequent rest periods
  • Diet: encourage normal healthy diet with regular meals
  • Education and employment support: in mild CFS/ME the emphasis is on encouraging  continuation of  regular work (if missing significant amounts of time off work/school, consider early referral)

Investigations prior to referral
  • Urinalysis
  • FBC UE LFT BONE TFT GLUCOSE CRP  with ES,  CK,  test for inflammation and myalgia
  • Coeliac testing if sufficient indication 
  • Ferritin (if age < 25)
  • Only perform further investigations if clinical picture raises an alternative diagnosis that needs excluding
 
Services available
  • Diagnostic opinion if diagnosis uncertain or complex co morbidities 
  • Medical assessment and medication management
  • Occupational and education liaison.
  • Evidence based therapeutic interventions, eg: GAT/GET/CBT approaches to managing activity and lifestyles, roles and responsibilities. 
  • Sleep, vestibular, anxiety, cognitive, pain, diet  and fatigue management strategies.  Plus specific neurological and  sensory integration based rehabilitation. 
  • Psychological interventions for coping, adjustment and overcoming barriers to accessing treatment strategies.
  • One to one, group work, local clinics and some domiciliary therapy appointment.

Current Team
 
Dr EJ Thacker
Carol Wilson
Dr Cristina Lopez Chertudi
Mel Terry, Cathy Jackson and Debby Ried.