GDG Round 1
Question and Results
GDG Round 2
Question and Results
Wider Group
Question and Results
Discussion
2(a)The use of thyroxine where the individual has LOW thyroxine levels is appropriate….
1. for adults with CFS/ME with mild symptomsAgreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2. for adults with CFS/ME with moderate symptomsAgreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
3. for adults with CFS/ME with severe symptomsAgreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
4. for children with CFS/ME with mild symptomsAgreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
5. for children with CFS/ME with moderate symptomsAgreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
6. for children with CFS/ME with severe symptomsAgreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2(b)The use of thyroxine where the individual has NORMAL thyroxine levels is appropriate….
1. for adults with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2.
2. for adults with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
3. for adults with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
4. for children with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
5. for children with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
6. for children with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2(c)The use of SSRIs where the individual is depressed is appropriate….The use of selective serotonin re-uptake inhibitors (SSRIs) (for example fluoxetine/Prozac or paroxetine/Seroxat) where the individual is moderately or severely depressed is INAPPROPRIATE….In the first round the GDG was unclear about the severity of symptoms of depression, the statement was clarified and went to round 2. See discussion about appropriate and inappropriate above.
1. for adults with CFS/ME with mild symptomsUncertainDisagreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
2. for adults with CFS/ME with moderate symptomsUncertainDisagreeUncertainRandom selection for wider survey
3. for adults with CFS/ME with severe symptomsAgreeDisagreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
1. for children with CFS/ME with mild symptomsNot includedUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
2. for children with CFS/ME with moderate symptomsNot includedUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
3. for children with CFS/ME with severe symptomsNot includedUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
2(c)The use of venlafaxine where the individual has pain difficulties AND is moderately or severely depressed is INAPPROPRIATEThis statement was added following the 1st round discussion
1. for adults with CFS/ME with mild symptomsNot includedDisagree….The GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
2. for adults with CFS/ME with moderate symptomsNot includedDisagree….The GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
3. for adults with CFS/ME with severe symptomsNot includedDisagree….The GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
2(c)The use of venlafaxine where the individual has sleep and pain difficulties AND is NOT moderately or severely depressed is INAPPROPRIATEThis statement was added following the 1st round discussion
1. for adults with CFS/ME with mild symptomsNot includedAgreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
2. for adults with CFS/ME with moderate symptomsNot includedAgreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
3. for adults with CFS/ME with severe symptomsNot includedAgreeAgreeRandom selection for wider survey
2(d)The use of Tricyclics where the individual is depressed is appropriate….The use of tricyclics (for example amitriptyline) where the individual has sleep and pain difficulties AND is moderately or severely depressed is INAPPROPRIATEIn the first round the GDG was unclear about the severity of symptoms of depression, the statement was clarified to indicate and progressed to round 2. See discussion about appropriate and inappropriate above.
1. for adults with CFS/ME with mild symptomsUncertainDisagreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
2. for adults with CFS/ME with moderate symptomsUncertainDisagreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
3. for adults with CFS/ME with severe symptomsUncertainDisagreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
4. for children with CFS/ME with mild symptomsUncertainDisagreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
5. for children with CFS/ME with moderate symptomsUncertainUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
6. for children with CFS/ME with severe symptomsUncertainUncertainDisagreeGDG was uncertain at round 2, progressed to wider survey
2(e)The use of tricyclics (for example amitriptyline) where the individual has sleep and pain difficulties AND is NOT moderately or severely depressed is INAPPROPRIATEThis statement was added following the 1st round discussion to test use without depression
1. for adults with CFS/ME with mild symptomsNot includedDisagreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
2. for adults with CFS/ME with moderate symptomsNot includedDisagreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
3. for adults with CFS/ME with severe symptomsNot includedDisagreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
4. for children with CFS/ME with mild symptomsNot includedUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
5. for children with CFS/ME with moderate symptomsNot includedUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
6. for children with CFS/ME with severe symptomsNot includedUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
2(f)The use of gabapentin where the individual is depressed is appropriate….The use of gabapentin where the individual has pain difficulties is INAPPROPRIATE.........This statement was clarified following the 1st round discussion. See discussion about appropriate and inappropriate above.
1. for adults with CFS/ME with mild symptomsDisagreeUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
2. for adults with CFS/ME with moderate symptomsDisagreeUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
3. for adults with CFS/ME with severe symptomsDisagreeUncertainDisagreeGDG was uncertain at round 2, progressed to wider survey
4. for children with CFS/ME with mild symptomsDisagreeUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
5. for children with CFS/ME with moderate symptomsDisagreeUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
6. for children with CFS/ME with severe symptomsDisagreeUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
2(g)The use of Monoamine oxidase inhibitors where the individual is depressed is appropriate….The use of monoamine oxidase inhibitors (for example phenelzine or isocarboxazid) where the individual has pain difficulties AND the individual is moderately or severely depressed is INAPPROPRIATE….This statement was clarified following the 1st round discussion. See discussion about appropriate and inappropriate above.
1. for adults with CFS/ME with mild symptomsDisagreeAgreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
2. for adults with CFS/ME with moderate symptomsDisagreeAgreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
3. for adults with CFS/ME with severe symptomsDisagreeAgreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
4. for children with CFS/ME with mild symptomsDisagreeUncertainAgreeGDG was uncertain at round 2, progressed to wider survey
5. for children with CFS/ME with moderate symptomsDisagreeUncertainAgreeGDG was uncertain at round 2, progressed to wider survey
6. for children with CFS/ME with severe symptomsDisagreeUncertainAgreeGDG was uncertain at round 2, progressed to wider survey
2(g)The use of monoamine oxidase inhibitors (for example phenelzine or isocarboxazid) where the individual has pain difficulties AND the individual is NOT moderately or severely depressed is INAPPROPRIATE….
T
This statement was added following the 1st round discussion to clarify the above.
1. for adults with CFS/ME with mild symptomsNot includedUncertainAgreeGDG was uncertain at round 2, progressed to wider survey
2. for adults with CFS/ME with moderate symptomsNot includedUncertainAgreeGDG was uncertain at round 2, progressed to wider survey
3. for adults with CFS/ME with severe symptomsNot includedAgreeAgreeRandom selection for wider survey
4. for children with CFS/ME with mild symptomsNot includedAgreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
5. for children with CFS/ME with moderate symptomsNot includedAgreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
6. for children with CFS/ME with severe symptomsNot includedAgreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2(h)The use of glucocorticoids (such as hydrocortisone) where the individual’s primary symptom is pain is appropriate….
1. for adults with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2. for adults with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
3. for adults with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2(i)The use of mineralocorticoids (such as fludrocortisone) where the individual’s primary symptom is pain is appropriate….
1. for adults with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2. for adults with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
3. for adults with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2(i)The use of Dexamphetamine where the individual’s primary symptom is fatigue is appropriate….
1. for adults with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2. for adults with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
3. for adults with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2(j)The use of methylphenidate where the individual’s primary symptom is fatigue is appropriate….
1. for adults with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2. for adults with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
3. for adults with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
4. for children with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
5. for children with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
6. for children with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2(k)The use of Melatonin is appropriate….The use of melatonin where the individual has sleep difficulties is INAPPROPRIATE….See discussion about appropriate and inappropriate above.
1. for children with CFS/ME with mild symptomsUncertainUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
2. for children with CFS/ME with moderate symptomsUncertainUncertainDisagreeGDG was uncertain at round 2
3. for children with CFS/ME with severe symptomsUncertainDisagreeDisagreeGDG was uncertain at round 2
2(l)The use of anti-herpes agents (such as acyclovir) where the individual has had herpes viral infection is appropriate….
1. for adults with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2. for adults with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
3. for adults with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
4. for children with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
5. for children with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
6. for children with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2(m)The use of anti-herpes agents (such as acyclovir) where the individual has NOT had herpes viral infection is appropriate….
1. for adults with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2. for adults with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
3. for adults with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
4. for children with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
5. for children with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
6. for children with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2(n)The use of gut anti-spasmodics (such as mebeverine, alverine and peppermint oil) where the individual has bowel symptoms is appropriate….The use of gut anti-spasmodics (such as mebeverine, alverine and peppermint oil) where the individual has bowel symptoms is INAPPROPRIATE.See discussion about appropriate and inappropriate above.
1. for adults with CFS/ME with mild symptomsUncertainDisagreeDisagreeRandom selection for wider survey
2. for adults with CFS/ME with moderate symptomsUncertainDisagreeDisagreeRandom selection for wider survey
3. for adults with CFS/ME with severe symptomsUncertainDisagreeThe GDG reached a consensus in the first round and the statement did not progress to wider survey.
4. for children with CFS/ME with mild symptomsUncertainDisagreeDisagreeRandom selection for wider survey
5. for children with CFS/ME with moderate symptomsUncertainDisagreeThe GDG reached a consensus in the first round and the statement did not progress to wider survey.
6. for children with CFS/ME with severe symptomsUncertainDisagreeThe GDG reached a consensus in the first round and the statement did not progress to wider survey.
2(o)The use of gut anti-spasmodics (such as mebeverine, alverine and peppermint oil) where the individual has NO bowel symptoms is appropriate….The GDG reached a consensus in the first round and the statement did not progress to Round 2
1. for adults with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2. for adults with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
3. for adults with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
4. for children with CFS/ME with mild symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
5. for children with CFS/ME with moderate symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
6. for children with CFS/ME with severe symptomsDisagreeThe GDG reached a consensus in the first round and the statement did not progress to Round 2
2(p)The use of skeletal anti- spasmodics (such as diazepam, baclofen, and clonazepam) where the individual has muscle pain, cramps or twitching is appropriate….The use of skeletal anti-spasmodics (such as diazepam, baclofen, and clonazepam) where the individual has MODERATE OR SEVERE muscle pain, cramps or twitching is INAPPROPRIATE….This statement was clarified following the 1st round discussion. See discussion about appropriate and inappropriate above.
1. for adults with CFS/ME with mild symptomsDisagreeUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
2. for adults with CFS/ME with moderate symptomsUncertainUncertainDisagreeGDG was uncertain at round 2, progressed to wider survey
3. for adults with CFS/ME with severe symptomsDisagreeDisagreeThe GDG reached a consensus in the first round and the statement did not progress to wider survey.
4. for children with CFS/ME with mild symptomsDisagreeUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
5. for children with CFS/ME with moderate symptomsDisagreeUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
6. for children with CFS/ME with severe symptomsDisagreeUncertainUncertainGDG was uncertain at round 2, progressed to wider survey
2(p)The use of skeletal anti-spasmodics (such as diazepam, baclofen, and clonazepam) where the individual has NO muscle pain is INAPPROPRIATE….This statement was clarified following the 1st round discussion to separate from above.
1. for adults with CFS/ME with mild symptomsNot includedAgreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
2. for adults with CFS/ME with moderate symptomsNot includedAgreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
3. for adults with CFS/ME with severe symptomsNot includedAgreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
4. for children with CFS/ME with mild symptomsNot includedAgreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
5. for children with CFS/ME with moderate symptomsNot includedAgreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.
6. for children with CFS/ME with severe symptomsNot includedAgreeThe GDG reached a consensus in the round 2 and the statement did not progress to wider survey.

From: 6, Management

Cover of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (or Encephalopathy)
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (or Encephalopathy): Diagnosis and Management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (or Encephalopathy) in Adults and Children [Internet].
NICE Clinical Guidelines, No. 53.
National Collaborating Centre for Primary Care (UK).
Copyright © 2007, Royal College of General Practitioners.

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