Pain in rib cage and tiredness: Chronic fatigue syndrome?

Patient: My friend is in his early 50’s and has recently become very tired.and now is experiencing pain in his lower left rib underneath. He’s not too concerned about it but I am as he has been sleeping much more and now this has come up.

Doctor: Chronic fatigue syndrome (CFS) is defined by two major criteria, chronic severe  fatigue for at least six months not ca caused by a diagnosable disease or relieved with rest and at least four other specific symptoms that occur at the same time or after the development of severe fatigue. Usually is associated with Fibromyalgia and costochondritis. The cause of CFS is unknown. Chronic fatigue syndrome (CFS) is a diagnosis made by excluding many diseases that have chronic fatigue as major or frequent symptom. Unfortunately, there are no physical signs or diagnostic tests that identify CFS. The diagnosis is made by fitting the two major criteria set out by a group of CFS research experts. The first criteria states the patient must have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis (a diagnosis by exclusion). The second criteria requires the patients have four or more of the following symptoms that either occurred at the same time or after the severe chronic fatigue. The symptoms are substantial impairment in short-term memory or concentration, sore throat, tender lymph nodes, muscle pain, multi-joint pain without swelling or redness, headaches of a new type, pattern or severity, non-refreshing sleep, and post-exertion malaise lasting more than 24 hours. Although there are no lab studies that identify CFS, lab studies do provide some supportive evidence for a diagnosis, for example: low erythrocyte sedimentation rate(ESR), elevated immunoglobulins against Coxsackie B virus, HHV-6 or chlamydia pneumoniae, decreased number of natural killer cells. I suggest to have a comprhensive evaluation for a Physician to rule out all the possible causes mentioned above.