Symptoms

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CHRONIC FATIGUE SYNDROME/FIBROMYALGIA SYMPTOM CHECKLIST (Katrina Berne's symptom checklist)

Please indicate on a scale of 1 to 10 the severity and frequency of each symptom, with 10 being the most severe and frequent. Use the past two months as a general guide. If you do not have the symptom, leave the space blank.

____ Fatigue, worsened by physical exertion or stress

____ Activity level decreased to less than 50% of pre-illness activity level

____ Recurrent flu-like illness

____ Sore throat

____ Hoarseness

____ Tender or swollen lymph nodes (glands), especially in neck & underarms

____ Shortness of breath with little or no exertion

____ Frequent sighing

____ Tremor or trembling

____ Severe nasal allergies (new or worsened)

____ Cough

____ Night sweats

____ Low-grade fevers

____ Feeling cold often

____ Feeling hot often

____ Cold extremities (hands and feet)

____ Low body temperature (below 97.6)

____ Low blood pressure (below 110/70)

____ Heart palpitations

____ Dryness of eyes and/or mouth

____ Increased thirst

____ Symptoms worsened by temperature changes

____ Symptoms worsened by air travel

____ Symptoms worsened by stress

PAIN

____ Headache

____ Tender points or trigger points

____ Muscle pain

____ Muscle twitching

____ Muscle weakness

____ Severe weakness of an arm or leg

___ ____ Full or partial paralysis of an arm or leg

____ Joint pain

____ TMJ syndrome

____ Chest pain

EYES AND VISION

____ Eye pain

____ Changes in visual acuity (frequent changes in ability to see well)

____ Difficulty with accommodation (switching focus from one thing to another)

____ Blind spots in vision

SENSITIVITIES

____ Sensitivities to medications (unable to tolerate a "normal" dosage)

____ Sensitivities to odors (e.g., cleaning products, exhaust fumes, colognes, hair sprays)

____ Sensitivities to foods

____ Alcohol intolerance

____ Alteration of taste, smell, and/or hearing

UROGENITAL

____ Frequent urination

____ Painful urination or bladder pain

____ Prostate pain

____ Impotence

____ Endometriosis

____ Worsening of premenstrual syndrome (PMS)

____ Decreased libido (sex drive)

GASTROINTESTINAL

____ Stomach ache; abdominal cramps

____ Nausea

____ Vomiting

____ Esophageal reflux (heartburn)

____ Frequent diarrhea

____ Frequent constipation

____ Bloating; intestinal gas

____ Decreased appetite

____ Increased appetite

____ Food cravings

____ Weight gain (_____ lbs)

____ Weight loss (_____ lbs)

OTHER ____ Rashes or sores

____ Eczema or psoriasis

____ Aphthous ulcers (canker sores)

____ Hair loss

____ Mitral valve prolapse

____ Cancer

____ Dental problems

____ Periodontal (gum) disease GENERAL NEUROLOGICAL

____ Lightheadedness; feeling"spaced out”

____ Inability to think clearly (“brain fog”)

____ Seizures

____ Seizure-like episodes

____ Syncope (fainting) or blackouts

____ Sensation that you might faint

____ Vertigo or dizziness

____ Numbness or tingling sensations

____ Tinnitus (ringing in one or both ears)

____ Photophobia (sensitivity to light)

____ Noise intolerance

EQUILIBRIUM/PERCEPTION

____ Feeling spatially disoriented

____ Dysequilibrium (balance difficulty)

____ Staggering gait (clumsy walking; bumping into things)

____ Dropping things frequently

____ Difficulty judging distances (e.g. when driving; placing objects on surfaces)

____ “Not quite seeing” what you are looking at

SLEEP

____ Hypersomnia (excessive sleeping)

____ Sleep disturbance: unrefreshing or non-restorative sleep

____ Sleep disturbance: difficulty falling asleep

____ Sleep disturbance: difficulty staying asleep (frequent awakenings)

____ Sleep disturbance: vivid or disturbing dreams or nightmares

____ Altered sleep/wake schedule (alertness/energy best late at night)

COGNITIVE ____ Difficulty with simple calculations (e.g., balancing checkbook)

____ Word-finding difficulty

____ Saying the wrong word

____ Difficulty expressing ideas in words

____ Difficulty moving your mouth to speak

____ Slowed speech

____ Stuttering; stammering

____ Impaired ability to concentrate

____ Easily distracted during a task

____ Difficulty paying attention

____ Difficulty following a conversation when background noise is present

____ Losing your train of thought in the middle of a sentence

____ Difficulty putting tasks or things in proper sequence

____ Losing track in the middle of a task (remembering what to do next)

____ Difficulty with short-term memory

____ Difficulty with long-term memory

____ Forgetting how to do routine things

____ Difficulty understanding what you read

____ Switching left and right

____ Transposition (reversal) of numbers, words and/or letters when you speak

____ Transposition (reversal) of numbers, words and/or letters when you write

____ Difficulty remembering names of objects

____ Difficulty remembering names of people

____ Difficulty recognizing faces

____ Poor judgment

____ Difficulty making decisions ____ Difficulty following simple written instructions

____ Difficulty following complicated written instructions

____ Difficulty following simple oral (spoken) instructions

____ Difficulty following complicated oral (spoken) instructions

____ Difficulty integrating information (putting ideas together to form a complete picture or concept)

____ Difficulty following directions while driving

____ Becoming lost in familiar locations when driving

____ Feeling too disoriented to drive

MOOD/EMOTIONS ____ Depressed mood

____ Suicidal thoughts

____ Suicide attempt(s)

____ Feeling worthless

____ Frequent crying

____ Feeling helpless and/or hopeless

____ Inability to enjoy previously enjoyed activities

____ Increased appetite

____ Decreased appetite

____ Anxiety or fear with no obvious cause

____ Panic attacks

____ Irritability; overreaction

____ Rage attacks: anger outbursts with little or no cause

____ Abrupt, unpredictable mood swings

____ Phobias (irrational fears)

____ Personality changes

The following is Katrina Berne's list of the most important symptoms.

GENERAL SYMPTOMS

Fatigue, worsened by physical exertion or stress

Activity level decreased to less than 50% of pre-illness activity level

Shortness of breath with little or no exertion

Recurrent flu-like illness (note: Some patients have flu-like symptoms only in the early stages, while others have frequent infections throughout the course of the illness.) Sore throat; hoarseness Tender or swollen lymph nodes (glands) Cough

Night sweats

Low-grade fevers

Severe nasal allergies (new or worsened)

Feeling cold often or feeling hot often

Cold extremities (hands and feet)

Low body temperature (below 97.6)

Low blood pressure (below 110/70)

Heart palpitations

Dryness of eyes and/or mouth

Increased thirst

Symptoms worsened by temperature changes

Symptoms worsened by stress (physical, emotional and/or cognitive)

PAIN

Headache

Tender points or trigger points

Muscle pain

Muscle weakness

Joint pain

Chest pain EYES AND VISION Eye pain

Changes in visual acuity (frequent changes in ability to see well)

Difficulty with accommodation (switching focus from one thing to another)

SENSITIVITIES Sensitivities to medications (unable to tolerate a "normal" dosage)

Sensitivities to odors (e.g., cleaning products, exhaust fumes, colognes, hairsprays)

Sensitivities to foods

Alcohol intolerance

Alteration of taste, smell, and/or hearing

UROGENITAL Frequent urination

Painful urination or bladder pain

Decreased libido (sex drive)

GASTROINTESTINAL Stomach ache; abdominal cramps

Nausea; vomiting

Esophageal reflux (heartburn)

Frequent diarrhea

Frequent constipation

Bloating; intestinal gas

Weight gain or loss (gain is more common)

OTHER Rashes or sores

Hair loss

Increased dental and periodontal problems

GENERAL NEUROLOGICAL

Lightheadedness; feeling"spaced out”

Inability to think clearly (“brain fog”)

Seizures or seizure-like episodes

Syncope (fainting) or blackouts or pre-syncope

Vertigo or dizziness

Numbness or tingling sensations

Tinnitus (ringing in one or both ears)

Photophobia (light sensitivity)

Noise intolerance

EQUILIBRIUM/PERCEPTION

Feeling spatially disoriented

Dysequilibrium (balance difficulty)

Clumsiness; frequently dropping things

Difficulty judging distances (e.g. when driving; placing objects on surfaces)

SLEEP Hypersomnia, often alternating with hyposomnia

Sleep disturbance:

   difficulty falling asleep
   difficulty staying asleep (awakenings)
   unrefreshing or non-restorative sleep 
   vivid or disturbing dreams or nightmares

Altered sleep/wake schedule (alertness/energy best late at night)

COGNITIVE Difficulty with simple calculations

Word-finding difficulty

Saying the wrong word

Impaired ability to concentrate Easily distracted during a task

Difficulty following a conversation when background noise is present

Losing your train of thought in the middle of a sentence

Difficulty putting tasks or things in sequence

Difficulty with short-term memory

Difficulty with long-term memory

Forgetting how to do routine things

Comprehension difficulty

Transposition (reversal) of numbers, words and/or letters when you speak or write

Difficulty remembering names of objects

Difficulty remembering names of people

Difficulty recognizing faces

Poor judgment

Difficulty making decisions

Difficulty following instructions:

    simple or complicated
    written or spoken

Difficulty integrating information (putting ideas together to form a concept)

Difficulty following directions while driving

Becoming lost in familiar locations when driving

Feeling too disoriented to drive

MOOD/EMOTIONS Depressed mood

Suicidal thoughts

Suicide attempt(s)

Feeling worthless

Frequent crying

Feeling helpless and/or hopeless

Appetite change: Increased or decreased

Anxiety with no obvious cause

Irritability; overreaction

Abrupt, unpredictable mood swings

These two lists are posted here by permission of Katrina H. Berne, provided they are not distributed on a for-profit basis and that her copyright notice appears at the end.

Symptoms

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