Many patients do not fully recover from CFS even with treatment, and there is no universally effective curative option. Diets, physiotherapy, dietary supplements, antidepressants, pain killers, pacing, and complementary and alternative medicine have been suggested as ways of managing CFS. Cognitive behavioural therapy (CBT) and graded exercise therapy (GET) have shown effectiveness for some patients in multiple randomized controlled trials. As many of the CBT and GET studies required patients to visit a clinic, severely affected patients may have been excluded.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT), a form of psychological therapy often used to treat chronically ill patients, that is "useful in treating some CFS patients."
A ''Cochrane Review'' meta-analysis of 15 randomized, controlled cognitive behavioral therapy trials with 1043 participants concluded that CBT was an effective treatment to reduce symptoms of fatigue. Comparing CBT with "usual care," four reviewed studies showed that CBT was more effective (40% vs 26%). In three studies, CBT worked better than other types of psychological therapies (48% vs 27%). The effects may diminish after a course of therapy is completed; the reviewers write that "the evidence base at follow-up is limited to a small group of studies with inconsistent findings" and encourage further studies. Another recent meta-analysis finds improvements in randomized controlled trials ranging from 33-73%. A systematic review published in 2006 included the same five RCTs, noting that "no severely affected patients were included in the studies of GET".
Pacing is an energy management strategy which encourages behavioral change while acknowledging patient fluctuations in symptom severity and delayed exercise recovery. Patients are advised to set manageable daily activity/exercise goals and balance activity and rest to avoid over-exertion which may worsen symptoms. Those able to function within their individual limits are encouraged to gradually increase activity and exercise levels while maintaining established energy management techniques. The goal is to gradually increase the level of routine functioning of the individual. A small randomised controlled trial concluded that pacing with GET had statistically better results than relaxation/flexibility therapy. A recent survey of 828 people suffering CFS found that pacing was evaluated as useful by 96% of the participants, whereas 79% of the participants who had experienced GET reported this had worsened their health status. Medications thought to have promise in alleviating stress-related disorders include antidepressant and immunomodulatory agents. Many CFS patients are sensitive to medications, particularly sedatives, and some patients report chemical and food sensitivities.
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