Fibromyalgia Monthly Newsletter

Treatment of Patients with Chronic Fatigue Syndrome

article syndicated from CDC

A variety of therapeutic approaches have been described as benefiting patients with chronic fatigue syndrome (CFS). Since no cause for CFS has been identified and the pathophysiology remains unknown, treatment programs are directed at relief of symptoms, with the goal of the patient regaining some level of pre-existing function and well-being. Although desirable, a rapid return to pre-illness health may not be realistic, and patients who expect this prompt recovery and do not experience it may exacerbate their symptoms because of overexertion, become frustrated, and may become more refractory to rehabilitation.

Decisions regarding treatment for CFS or any chronically fatiguing illness should be made only in consultation with a health care provider. The health care provider, together with the patient, will develop an individually tailored program that provides the greatest benefit. This treatment program will be based on assessment of the patient’s overall medical condition and current symptoms, and will be modified over time on the basis of regular follow-up and assessment of the patient’s changing condition. Currently, most health care providers with experience in treating persons with CFS use some combination of the therapies discussed below. Persons who have questions about a particular treatment should contact a qualified health care provider, local medical society, or university medical school for additional information.

Some proposed treatments are unproven and may be harmful. Therapy should not aggravate existing symptoms or create new ones. It should not mask another illness that needs identification and specific treatment. Finally, therapy should not impose an excessive financial burden on the patient.

As a service to CFS patients and other interested persons, this section provides some basic information about different therapies that have been used for the treatment of patients with CFS. These descriptions are intended only for general informational purposes. The Agency for Healthcare Research and Quality has recently completed an Evidence Report Defining and Managing Chronic Fatigue Syndrome that can be downloaded from their website.

Non-Pharmacologic Therapy

Physical Activity

An appropriate amount of physical activity is required by everyone for physical and emotional well-being. Patients with CFS are no exception. A key consideration for patients with CFS is to know how much to do and when to stop the activity. Regardless of the level of activity a patient with CFS may attempt, the most important guideline is to avoid increasing the level of fatigue.

In general, health care providers advise patients with CFS to pace themselves carefully and encourage them to avoid unusual physical or emotional stress. The paced activity can be counter-productive if it increases fatigue or pain. A regular, manageable daily routine helps avoid the "push-crash" phenomenon characterized by overexertion during periods of better health, followed by a relapse of symptoms perhaps initiated by the excessive activity. Although patients should be as active as possible, clinicians may need to explain the disorder to employers and family members, advising them to make allowances as possible. Modest regular exercise to avoid de-conditioning is important. The program of exercise and/or the exercise itself should be supervised by a knowledgeable health care provider or physical therapist. Such supervision is particularly important for severely compromised patients.

Non-pharmacologic therapies that have a passive physical component sometimes used by CFS patients include massage therapy, acupuncture, chiropractic, cranial-sacral, massage, self-hypnosis, and therapeutic touch. These modalities may contribute to feeling better, but they are most effective when combined with patient-generated activity, including aquatic therapy, light exercise (adapted to personal capabilities), and stretching. Some patients may tolerate activities such as yoga and tai chi that require more energy.

Education

Learning about what CFS is and what it is not is a critical component of therapy. This approach includes learning how to adjust activities and behaviors that may aggravate the illness. A formal method to impart this information is known as cognitive behavioral therapy. Cognitive behavioral therapy has been shown to facilitate patient coping and to allow increased activities without triggering increased symptoms. Any chronic illness, including CFS, can affect the patient’s family. Family education may foster good communication and reduce the adverse effect of CFS on the family.

Pharmacologic Therapy

Pharmacologic therapy is directed toward the relief of specific symptoms experienced by the individual patient. Patients with CFS appear particularly sensitive to many medications, especially those that affect the central nervous system. Thus, the usual treatment strategy is to begin with very low doses and to gradually increase dosage as necessary and as tolerated. It is important to remember that use of any drug for symptom relief should be attempted only if an underlying cause for the symptom in question has not been found. The best example is use of a sleep-enhancing medication for non-restorative sleep. Although the patient may state that they sleep better, the sleep disorder remains obscured and thus treatment of the sleep disorder not given. It is also important to remember that all medications can cause untoward side effects, which may lead to new symptoms.