Chronic fatigue syndrome is a common syndrome of unrelenting fatigue and several other symptoms of at least six months’ duration, resulting in significant disability and reduction in personal, occupational, educational and social status.
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Diagnosis of the condition can only be made after other potential (medical and psychiatric) causes of fatiguing disease have been excluded. Chronic fatigue syndrome was previously known as neurasthenia and myalgic encephalomyelitis.
Accordingly, appropriate management of the syndrome is cumbersome and time-consuming. Since there is no cure, the treatment is aimed to reducing and easing symptoms.
In certain patients the progression of the illness can be halted to a certain extent, however, such treatments do not last forever, and cannot halt progression completely. Hence, various modalities (some quite unconventional) have been introduced for the treatment of this condition.
In the last two decades, a heated debate regarding chronic fatigue syndrome and exercise unfolded among scientists, medical practitioners, but also among patients.
Few diseases have been discussed so meticulously – even the existence of the disorder itself has been brought under question, its pathophysiology debated, and potentially effective treatment modalities opposed. Patients’ organizations are still keen to participate in scientific discussions.
Cognitive behavioral therapy
The fundamental idea behind cognitive behavioral therapy (CBT) in the treatment of chronic fatigue syndrome is to aid patients to develop useful strategies for improving day-to-day functioning.
One of the goals is also to dispel erroneous beliefs and impressions that may perpetuate the condition.
A Cochrane review on CBT for chronic fatigue syndrome in adults showed that affected individuals undergoing this type of treatment were more likely to show diminished fatigue symptoms upon completion of the treatment (40% of patients) in comparison with those who underwent usual care (26% of patients).
This therapy is also thought to be more effective in lessening fatigue symptoms when compared to other psychological therapies.
However, authors of the aforementioned review caution that more research has to be done to establish whether a combination treatment of CBT with some other treatment modalities represents a better approach, and more acceptability studies should be pursued. Furthermore, in some cases, CBT may aggravate a patient’s condition, which has to be recognized early in the course of treatment.
Exercise as a treatment modality has a proven track record in practical medicine, thus it was presumed that it could be efficacious for certain patients with CFS as well.
An updated version of the Cochrane review that analyzed eight studies hinted that exercise ameliorates fatigue symptoms, but the probability of improvement in daily function (or recovery) is quite small. According to the provisional acceptability data, most patients are ready to include exercise in their daily routine.
Nonetheless, one key study (also known as PACE trial) which was influential for the conclusions of the aforementioned Cochrane review (mostly due to its power) has raised substantial controversy, as it lacked clarity on outcomes. After the release of primary data from the PACE trial, re-analysis indicated that the effect sizes are smaller than initially reported.
Although exercise did not seem to worsen symptoms for people battling with CFS, the question remains is as to whether there is any benefit. Significant side effects were rarely observed, although limited information in the studies thus far pose difficulties for drawing steadfast conclusions regarding exercise therapy safety.
At the moment there are no specific or universal drugs approved by the (FDA) for the treatment of chronic fatigue syndrome, even though some medications are given off-label to the affected individuals. In addition, just a handful of randomized controlled trials have interrogated and evaluated pharmacological treatments for this condition.
The list of pharmaceuticals that are prescribed for chronic fatigue syndrome is sizeable, ranging from over‐the‐counter drugs (most notably pain relievers and nonsteroidal anti‐inflammatory drugs), antidepressants, anticonvulsants, and narcotics, to immunomodulatory and antiviral drugs.
The rationale is that treatments should be aimed both at reducing the wide variety of symptoms and addressing secondary infections present in the majority of patients with chronic fatigue syndrome.
Other modalities and lifestyle modifications
Individuals with chronic fatigue syndrome tend to utilize more alternative medicine modalities than people without it. Patients incline to leave science-based medical care because they perceive that their condition has been unwarrantably ascribed to psychological causes.
However, albeit a large percentage of patients state that alternative treatments are helpful, there is no evidence in the scientific and medical literature supporting those claims.
Patients with chronic fatigue syndrome are often encouraged to set physical activity goals. Realistic goal setting can help in improving self-confidence, as well as increasing physical ability.
Certain relaxation techniques (such as meditation) are advocated and sleeping habits have to be regulated in order to avert sleep disorders.
In addition, patients are advised to avoid stress, caffeine, alcohol, simple sugars and foods they may be allergic to.
Supplements may benefit individuals that show specific nutritional inadequacies, alongside chronic fatigue syndrome. Although, biochemical testing for deficiencies should be carried out prior to recommending a specific supplementation regimen.
This article was originally written by Dr. Ananya Mandal, MD, but was updated in August 2018 by Dr. Tomislav Meštrović, MD, Ph.D.