From the Guidelines
The current treatment for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and chronic Epstein-Barr Virus (EBV) focuses on symptom management, with pacing activities to avoid post-exertional malaise and personalized approaches combining lifestyle modifications, medications, and supportive therapies being crucial. According to the most recent study 1, pacing is essential for managing post-exertional malaise, and medications such as low-dose naltrexone (3-4.5mg daily) may be helpful for pain and fatigue.
Medications and Therapies
- Low-dose naltrexone (3-4.5mg daily) may be helpful for pain and fatigue, as suggested by the study 1.
- Antidepressants like duloxetine (30-60mg daily) or amitriptyline (10-25mg at bedtime) may be used for pain and sleep disturbances.
- Anti-inflammatory medications may be used as needed.
- For chronic EBV, treatment is similar, with some physicians trying valacyclovir (1g twice daily) or valganciclovir in selected cases.
- Supportive measures include addressing sleep problems, managing orthostatic intolerance, and nutritional support focusing on a balanced anti-inflammatory diet.
Lifestyle Modifications
- Pacing activities to avoid post-exertional malaise is crucial, with gradual, carefully monitored increases in activity as tolerated.
- Increased salt and fluid intake or medications like fludrocortisone (0.1-0.2mg daily) may be used to manage orthostatic intolerance.
- Nutritional support focusing on a balanced anti-inflammatory diet with consideration of vitamin B12, vitamin D, and CoQ10 supplements if deficient is essential.
Recent Findings
The study 1 highlights the importance of developing and validating biomarkers for long COVID, which may also be applicable to ME/CFS. Additionally, treatments such as intravenous immunoglobulin, anticoagulants, and apheresis have shown promise in addressing certain components of long COVID. However, exercise is harmful for patients with long COVID who have ME/CFS or postexertional malaise and should not be used as a treatment, as noted in the study 1.
From the Research
Current Treatment for ME/CFS
- The current treatment for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is focused on relieving symptoms and improving quality of life, as there is no established cure for the disease 2.
- Treatment approaches may include personalized pacing programs to manage energy levels and relieve symptoms, as well as the administration of nutritional supplements for patients with demonstrated deficiencies 3.
- Some studies suggest that rintatolimod, rituximab, and counseling or behavioral therapy programs may be beneficial for ME/CFS patients, but the evidence is limited and more research is needed to confirm their effectiveness 3.
Treatment for Chronic EBV
- There is evidence to suggest that Epstein-Barr Virus (EBV) may play a role in the development of ME/CFS in some patients, and anti-EBV therapies may be effective in selected patients 4.
- However, more research is needed to fully understand the relationship between EBV and ME/CFS, and to develop effective treatments for patients with chronic EBV infection.
Avoiding Harmful Therapies
- Graded Exercise Therapy (GET) and Cognitive Behavioral Therapy (CBT) are no longer recommended as treatments for ME/CFS, as they have been shown to be ineffective and potentially harmful for many patients 5, 2.
- Clinicians should be aware of the potential risks of these therapies and instead focus on providing personalized care and support to patients with ME/CFS.