What are the treatment options for Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS)?

From the Guidelines

Treatment for chronic fatigue syndrome (CFS) should prioritize cognitive-behavioral therapy and mindfulness-based therapies as first-line interventions, as they have shown significant improvements in health function, health-related quality of life, and physical function in patients with CFS, as supported by the 2022 study published in Mayo Clinic Proceedings 1.

Key Recommendations

• Cognitive-behavioral therapy has the greatest evidence for improving health function, health-related quality of life, and physical function in patients with CFS, with multiple studies demonstrating significant benefits 1.
• Mindfulness-based therapies, such as mindfulness-based stress reduction and meditation awareness training, have also shown strong evidence for reducing functional impairment and improving quality of life in patients with CFS 1.
• Exercise, including yoga and tai chi, can be beneficial for patients with CFS, but should be started very conservatively to avoid post-exertional malaise 1.
• Pharmacological interventions, such as low-dose antidepressants and pain management medications, may be considered on a case-by-case basis, but should not be the primary treatment approach 1.

Important Considerations

• Treatment effectiveness varies significantly between individuals, and patients should work closely with healthcare providers to develop a personalized approach that addresses their specific symptoms and adjusts as needed over time.
• The use of stimulants, such as modafinil, should be approached with caution and only considered under the guidance of a healthcare provider, as the evidence for their effectiveness in CFS is limited and they may have significant side effects 1.
• Non-pharmacological interventions, such as sleep hygiene practices, nutritional support, and stress management, should be prioritized as part of a comprehensive treatment plan for CFS.

From the Research

Treatment Options for Chronic Fatigue Syndrome

• Cognitive behavioral therapy (CBT) and graded exercise therapy (GET) are promoted as evidence-based treatments for myalgic encephalomyelitis/chronic fatigue syndrome 2, 3, 4, 5.
• CBT has been shown to improve physical function and fatigue in patients with mild to moderate chronic fatigue syndrome 6.
• GET can also improve outcomes for chronic fatigue syndrome, but patients' organizations have reported that these treatments can be harmful and favor pacing and specialist health care 2, 4.
• Pacing therapy is the most favored treatment with the lowest negative response rate and the highest reported benefit, with 44%-82% of patients reporting benefits 2.
• Adaptive pacing therapy (APT) is not an effective addition to specialist medical care for chronic fatigue syndrome 4.
• There is insufficient evidence about the effectiveness of pharmacological, supplements, complementary/alternative, and other interventions for chronic fatigue syndrome 5.

Effectiveness of Treatments

• CBT and GET can safely be added to specialist medical care to moderately improve outcomes for chronic fatigue syndrome 4.
• A 16-week standard CBT intervention improves physical function and fatigue in CFS outpatients with mild to moderate disease 6.
• A shorter 8-week interpersonal oriented CBT program improves physical function, but the effect on fatigue is not substantial 6.
• The positive change in physical function persists at 1-year follow-up for both treatment groups, and for standard CBT also in fatigue 6.

Safety of Treatments

• Serious adverse reactions were recorded in a small percentage of participants in the APT, CBT, and GET groups 4.
• No serious adverse reactions were recorded in any of the groups during the trial period of a consecutive randomized controlled trial of standard and short CBT interventions 6.