From the Guidelines
The recommended treatment approach for chronic fatigue syndrome involves cognitive-behavioral therapy (CBT), which has shown significant improvement in health function, health-related quality of life, or physical function, as evidenced by multiple studies, including a meta-analysis of 29 studies and a systematic review 1.
Treatment Approach
The treatment of chronic fatigue syndrome should be personalized and multidisciplinary, focusing on addressing symptoms and improving quality of life.
- Cognitive-behavioral therapy (CBT) is a key component of treatment, with strong evidence supporting its use in patients with chronic fatigue syndrome, as it has been shown to improve physical functioning compared to control 1.
- Mindfulness-based therapies also have strong evidence supporting their use, with studies showing improvements in daily functioning and quality of life in patients with chronic fatigue syndrome and other chronic multisymptom illnesses 1.
- Exercise, such as graded exercise therapy (GET), can be beneficial, but it is essential to start with very low-intensity physical activity and gradually increase duration as tolerated to avoid exacerbating symptoms.
- Sleep hygiene improvements, including maintaining consistent sleep schedules and limiting daytime napping, are also crucial in managing chronic fatigue syndrome.
- Pain management may involve over-the-counter medications or prescription medications, such as low-dose amitriptyline, to address both pain and sleep disturbances.
- Pacing activities throughout the day can help manage energy levels and prevent post-exertional malaise.
Important Considerations
- Stimulants should not be offered for treatment of fatigue in patients with chronic fatigue syndrome, as there is a recommendation against their use 1.
- Duloxetine should not be recommended for or against, as there is insufficient evidence to support its use in patients with chronic fatigue syndrome 1.
- Psychodynamic therapies should also not be recommended for or against, due to insufficient evidence 1.
- Treatment should be tailored to the individual patient's needs and preferences, taking into account their unique symptoms and circumstances.
From the Research
Treatment Approaches for Chronic Fatigue Syndrome
The treatment of chronic fatigue syndrome (CFS) involves a combination of therapies to manage symptoms and improve quality of life. Some of the recommended treatment approaches include:
- Cognitive behavior therapy (CBT) to help patients change their thoughts and behaviors associated with fatigue 2, 3, 4, 5
- Graded exercise therapy (GET) to help patients gradually increase their physical activity levels 2, 3, 5
- Adaptive pacing therapy (APT) to help patients manage their energy levels and avoid exacerbating fatigue 5
- Mindfulness-based cognitive therapy (MBCT) to help patients manage stress and improve their overall well-being 4
- Specialist medical care to address any underlying medical conditions that may be contributing to fatigue 5
Key Considerations for Treatment
When treating CFS, it is essential to consider the following:
- A thorough clinical assessment is necessary to determine the best course of treatment 2
- Treatment should be tailored to the individual patient's needs and preferences 2, 5
- Patients should be educated about pacing their activity to avoid exacerbating fatigue 6
- Comorbidities and symptoms should be prioritized and addressed based on severity 6
Effectiveness of Treatment Approaches
Research has shown that CBT and GET can be effective in reducing fatigue and improving physical function in patients with CFS 2, 3, 5. MBCT has also been shown to be a promising additional intervention for patients who are still experiencing excessive fatigue after CBT 4. However, APT has not been found to be an effective addition to specialist medical care 5.