Clinical recommendation	Evidence rating	References
Persons with chronic fatigue should have an evaluation, including history, physical examination, and initial laboratory testing (i.e., urinalysis; complete blood count; comprehensive metabolic panel; and measurement of thyroid-stimulating hormone, C-reactive protein, and phosphorus levels).	C	7, 8
Persons diagnosed with chronic fatigue syndrome should be evaluated and treated for comorbidities, such as sleep disturbance, depression, and pain. Any comorbidity identified should be treated.	C	7, 8
Persons diagnosed with chronic fatigue syndrome should be treated with cognitive behavior therapy, graded exercise therapy, or both. Cognitive behavior therapy and graded exercise therapy have been shown to improve fatigue, work and social adjustment, anxiety, and postexertional malaise.	A	22, 23, 26, 28, 29