[Tiredness/Fatigue-S3 guideline update].

Abstract

BACKGROUND: Fatigue is one of the most common reasons for seeking medical counseling in the family medicine (FM), often entailing diagnostic uncertainty.  Patients use terms describing emotional, cognitive, physical, and behavioral  aspects. A number of biological, mental, and social causes may underlie the  symptom of fatigue, often in combination. This guideline describes the procedures  to be applied for primary undetermined symptomatology. METHODS: The experts  involved conducted a systematic search using the terms for fatigue in the context  of FM in PubMed, Cochrane Library and via manual search. Concerning related  guidelines, the National Institute for Health and Care Excellence (NICE)  guideline was used for myalgic encephalitis/chronic fatigue syndrome (ME/CFS). In  a structured consensus process, broad approval of the core  recommendations/background text of the revised guideline was attained. MOST  IMPORTANT MESSAGES: 1) Alongside gathering information concerning the symptom  characteristics, the anamnesis aims to collect information about pre-existing  health conditions, sleeping behavior, use of drugs and psychosocial factors.  2) Depression and anxiety as two common causes will be identified based on  screening questions. The occurrence of post-exertional malaise (PEM) will be  inquired. 3) The following basic diagnostics are recommended: physical  examination, laboratory tests (blood glucose, full blood count, blood  sedimentation/CRP, transaminases/γ-GT, TSH). 4) Further examinations should be  conducted only in case of specific indications. 5) A biopsychosocial approach is  to be adopted. 6) Behavioral therapy and symptom-oriented activating measures can  improve fatigue in underlying diseases and undetermined fatigue. 7) In case of  PEM, further ME/CFS criteria should be collected and patients have to be  supervised accordingly.