Approach to managing persistent unexplained fatigue

After significant causes and contributing factors have been excluded (see Fatigue: diagnostic process), many patients remain troubled by some degree of persistent fatigueHamilton, 2010, sometimes accompanied by other somatic symptoms. The literature about causes and management of persistent fatigue continues to evolve; however, there is a lack of clear evidence to guide management, which can make this a challenging condition for health practitioners and patients.

Review patients with persistent unexplained fatigue regularly for new or worsening symptoms, and to reiterate general health advice. Unless a patient has significant new symptoms or physical signs, further or repeated investigations are often unhelpful and unnecessary. A review of previous test results can reassure patients that their symptoms are being taken seriously, and avoid further testing (see When to investigate fatigue).

Note: Unless significant new symptoms or physical signs emerge in a patient with persistent fatigue, further or repeated investigations are often unhelpful and unnecessary.

The approach to care outlined for myalgic encephalomyelitis / chronic fatigue syndrome (eg pacing, symptom management) may be useful in supporting people with other forms of persistent unexplained fatigue.

Patients with persistent unexplained fatigue value support from a strong, compassionate, therapeutic relationship with their general practitioner. It is often difficult for patients and their carers and families to accept that persisting fatigue might be unexplained and that it sometimes resolves spontaneously.

A second opinion by an experienced physician to review the assessment approach and confirm findings may reassure patients, families and carers. Referral to a medical practitioner with expertise in myalgic encephalomyelitis / chronic fatigue syndrome may also be appropriate.