Treatment for Chronic Fatigue Syndrome

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Written by Dr. Varshini Jayaraman,  Ph.D. | Medically Reviewed by The Medindia Medical Review Team  on Mar 05, 2016
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Treatment for Chronic Fatigue Syndrome

As the exact cause of CFS is not known, treatment is largely based on provision of symptomatic relief, helping the patient restore his near normal functionality. It should however be remembered that it may not be possible to achieve this instantaneously. Infact most patients out of anxiety, overexert themselves only to land up with more fatigue and depression. A carefully designed rehabilitation program can overcome all these factors.

It is very essential to discuss the severity of CFS and its impact on functional capability of an individual, with the health care provider who can then draft an individualized health care program. It is equally important to also educate the patient regarding CFS and alert them regarding certain activities that may aggravate the symptoms. Cognitive behavioral therapy, targeted at provision of CFS related education can allow for increased level of activity without increase in the frequency or severity of symptoms. Depending on the patient's improvement, further follow up treatment can be adjusted. Treatment for CFS is currently based on a multi-disciplinary approach.

Physical Activity

It is known that physical activity enhances the physical and mental health of an individual. Patients with CFS may be encouraged to participate in various forms of physical activity. It is however important to ensure that the patient understands his/her limitations to avoid any increase in the level of fatigue.

It is strongly recommended that CFS patients take up a moderate exercise program; under the supervision of a physical therapist or any other health care provider familiar with CFS and its treatment. Patients can also be advised regarding the 'push-crash' phenomenon, characterized by excessive physical activity during periods of better health followed by periods of fatigue due to excess activity. The exercise regime can incorporate any form of physical activity such as light exercise, stretching, aquatic therapy etc. In some cases where the patient's energy is not severely compromised, the patient may be encouraged to participate in yoga.

In addition to the above-mentioned forms of treatment with an active physical component, acupuncture, massage therapy, self-hypnosis etc can also be suggested. Although these modalities can improve the general well being, they are more effective when combined along with any form of patient-generated activity.

Drug Therapy

Pharmacologic therapy is based on use of certain drugs to provide symptomatic relief to the patient. This form of therapy can be applied only when the underlying symptom cannot be attributed to any known cause and all other differential diagnosis has been ruled out. Owing to increased sensitivity of CFS patients to certain medications, it is advisable to start a drug therapy at very low doses. Depending on the therapeutic benefit and the patient's tolerability, the dose can be increased progressively.

NSAIDs: This class of drugs commonly referred to as non-steroidal anti-inflammatory drugs can be used to relieve the pain experienced by CFS patients. As many of the drugs can lead to dangerous side effects, patients have to be closely monitored regarding the same.

Antidepressants: Tricyclic antidepressants are the most commonly used drugs to treat depression, in addition to providing relief from mild pain and improving sleep. Other class of antidepressants includes monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs). In some cases where CFS is associated with nervous system disorders such as vertigo, skin tenderness, and abnormal limb movements, specific anxiolytic agents may be given to attenuate the associated anxiety. Anxiolytic agents however should not be prescribed for generalized CFS treatment.

Stimulants: Treatment with stimulant drugs may be necessary when CFS is associated with extreme lethargy or daytime sleepiness. Extreme caution is however necessary before such drugs can be prescribed.

Antimicrobials: If the patient is observed to be suffering from current infections, treatment with appropriate antibiotics, antiviral or antifungal drugs may be necessary. Additionally, recurrent episodes of allergy may be managed with non-sedating antihistamines.

References:

  1. Chronic Fatigue Syndrome - (http://www.nlm.nih.gov/medlineplus/chronicfatiguesyndrome.html)
  2. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - (http://www.cdc.gov/ncidod/diseases/cfs/)

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Joowlz

I have all these symptoms of ME/CFS for over a year and had presented to my GP with symptoms but at time they seem unrelated. Recently when I told her I believed I had it, her comments were "You don't have it by what I know although you are definitely stressed, and definitely fatigued". When I responded that I had sore throat/tender glands in my neck and that if I do more than normal activity I am wrecked afterwards and sometimes have flu like illness without being the bug, she did not reply. It left me angry she did not take me seriously although my counsellor whom is also a registered doctor agreed with my diagnosis. It is unfortunate no lab. tests exist to prove this. What I think confuses my doctor is the fact I am 51 and have chronic pain treated with prescribed narcotics but she cannot explain sudden weight gain [12kg] in a year as well as all the other chronic fatigue like signs! Thanks, Jem

As described CFS is a set of symptoms and not a disease by itself. the underlying causes are still unknown to medical science but due to some medical conditions also you can get these kind of symptoms [Syndrome]. I just read in another article about 'andropause'. a situation described similar (although not) to menapause in women. Here the level of Testestorone (male hormone) gets depleted. This can be tested in blood test. Also other conditions include vit B12 deficiency, clinical depression, anxiety disorders, etc. You can rule out some of them as there are tests available. As you have described, you were on pain management medicines that may also have such side effects. Also, acceptance / non-acceptance by your doctor should not mean anything to you. Its the right treatment is required for the same. So, first thrash out the possibilities where tests are available (Vit B12, TSH, testestorone level, etc) and then you'll be sure about this yourself. All the best!

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