From the Guidelines
Cognitive-behavioral therapy (CBT) is recommended as a first-line treatment for chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), as it has been shown to improve health function, health-related quality of life, and physical function in patients with ME/CFS 1.
Treatment Approach
The management of CFS/ME typically involves a personalized, multidisciplinary approach, focusing on symptom management and improving quality of life rather than curing the condition.
- Energy conservation through pacing activities is crucial, as patients should balance activity with rest periods to avoid post-exertional malaise.
- Addressing comorbid conditions such as depression or anxiety may require specific medications or therapy.
- Nutritional support with a balanced diet and proper hydration is important, though no specific diet has proven universally effective.
Controversies and Precautions
Graded exercise therapy (GET) has become controversial as some patients report worsening symptoms, and its use is not recommended without careful consideration of the individual patient's needs and preferences 1.
- Some studies suggest that CBT and GET may be harmful to some patients, and their use should be approached with caution 1.
Evidence-Based Recommendations
The most recent and highest-quality study recommends CBT as a first-line treatment for CFS/ME, with mindfulness-based therapies also showing promise 1.
- The use of opioid medications, mifepristone, and stimulants is not recommended for the management of CFS/ME due to lack of evidence or potential harm 1.
From the Research
First Line Treatment for Chronic Fatigue Syndrome
The first line treatment for chronic fatigue syndrome is a topic of ongoing research and debate.
- According to a study published in the Lancet in 2011 2, cognitive behavioural therapy (CBT) and graded exercise therapy (GET) can be effective treatments for chronic fatigue syndrome.
- A systematic review published in JAMA in 2001 3 also found that graded exercise therapy and cognitive behavioural therapy showed positive results and scored highly on validity assessment.
- Another study published in the Journal of the Royal Society of Medicine in 2006 4 found that graded exercise therapy and cognitive behaviour therapy appeared to reduce symptoms and improve function based on evidence from randomized controlled trials.
- However, a study published in Clinical Rheumatology in 2011 5 found that multidisciplinary treatment combining CBT, GET, and pharmacological treatment was not superior to usual treatment at 12 months in terms of health-related quality of life.
- A review published in Expert Opinion on Pharmacotherapy in 2010 6 stated that pharmacotherapy can currently not be considered first-line treatment in CFS and should always be used in a context of self-management and rehabilitation.
Treatment Options
Some treatment options for chronic fatigue syndrome include: