The NICE guidelines

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The NICE Guidelines explained

ME/CFS is suspected if your symptoms have persisted for a minimum of 6 weeks.

These symptoms are…

  • Debilitating fatigue, worsened by activity.
  • Post-exertional malaise after activity.
  • Unrefreshing sleep.
  • Cognitive difficulties – in concentrating, memory, finding words or numbers.

A medical assessment and physical examination are carried out, and a number of tests to rule out other diagnoses.

  • urine analysis
  • full blood count (FBC)
  • urea & electrolytes (U&E’s)
  • liver function
  • thyroid function
  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • calcium & phosphate
  • HbA1c (diabetes)
  • serum ferritin (iron)
  • coeliac screening
  • creatine kinase

 A diagnosis can only be confirmed after 3 months of persistent symptoms.

Other tests

  • Vitamin D
  • Vitamin B12
  • folate levels
  • serological tests if a history of infection
  • 9am cortisol for adrenal insufficiency

Recommended Advice

Symptom management

  • not to push through or use more energy than you have
  • to rest and convalesce
  • to maintain a healthy balanced diet and have an adequate fluid intake.

Other associated symptoms

Orthostatic intolerance and Autonomic dysfunction including…

  • dizziness
  • palpitations
  • fainting
  • nausea on standing or sitting from a reclined position.

Temperature hypersensitivity

  • profuse sweating
  • chills
  • hot flushes
  • feeling very cold

Neuromuscular symptoms

  • twitching
  • myoclonic jerks

Flu-like symptoms

  • sore throat
  • tender glands
  • nausea
  • chills
  • muscle aches

Intolerance to

  • alcohol
  • foods
  • chemicals

Heightened sensory sensitivity

  • light
  • sound
  • touch
  • taste
  • smell


  • on touch
  • myalgia (muscles)
  • headaches
  • eye pain
  • abdominal pain
  • joint pain (without swelling, redness or fluid)

ME/CFS Specialist Teams

These consist of trained healthcare professionals experienced in assessing, diagnosing, treating and managing ME/CFS.

NHS ME/CFS Specialist Services – The ME Association