From the Guidelines
The most effective treatment approach for chronic fatigue syndrome is cognitive-behavioral therapy, as it has been shown to significantly improve health function, health-related quality of life, and physical function in patients with chronic multisymptom illness, including those with symptoms consistent with myalgic encephalomyelitis/chronic fatigue syndrome 1.
Treatment Overview
The treatment of chronic fatigue syndrome focuses on managing symptoms and improving quality of life. According to the 2021 US Department of Veterans Affairs and US Department of Defense clinical practice guideline, cognitive-behavioral therapy has the greatest evidence supporting its use in patients with chronic multisymptom illness, including those with symptoms consistent with myalgic encephalomyelitis/chronic fatigue syndrome 1.
Key Components of Treatment
- Cognitive-behavioral therapy: This approach has been consistently shown to improve health function, health-related quality of life, and physical function in patients with chronic fatigue syndrome 1.
- Mindfulness-based therapies: These therapies have also been found to be effective in reducing functional impairment and improving quality of life in patients with chronic fatigue syndrome 1.
- Exercise: While exercise is important, it should be graded and started with very gentle activity that gradually increases over time to avoid post-exertional malaise.
- Medications: There is insufficient evidence to recommend for or against offering duloxetine for patients with chronic fatigue syndrome, and stimulants are not recommended for treatment of fatigue in these patients 1.
Additional Considerations
- Patient preferences and resource availability should be considered when developing a treatment plan.
- A multidisciplinary team approach, including physical therapists, psychologists, and sleep specialists, may be beneficial for some patients.
- Comorbid conditions, such as depression, anxiety, or orthostatic intolerance, should be addressed as part of the treatment plan.
- Treatment must be individualized, as symptoms and severity vary widely between patients, and improvement often occurs gradually over months rather than days or weeks.
From the Research
Treatment Approaches for Chronic Fatigue Syndrome
- The treatment of chronic fatigue syndrome (CFS) may involve a combination of different therapeutic modalities, including exercise therapy, cognitive-behavioural therapy (CBT), and adaptive pacing therapy 2.
- Exercise therapy has been shown to be effective in reducing fatigue and improving physical function in patients with CFS, with no evidence suggesting that it may worsen outcomes 3.
- CBT and graded exercise therapy (GET) have also been found to be effective treatments for CFS, with studies showing that they can moderately improve outcomes for patients with the condition 4, 5.
- Adaptive pacing therapy, on the other hand, has been found to be less effective than CBT and GET in improving outcomes for patients with CFS 4.
Components of Treatment
- Exercise therapy for CFS may involve aerobic exercise, such as walking, swimming, or cycling, and may be provided at varying levels of intensity 3.
- CBT for CFS typically involves 14 sessions over 23 weeks, with a booster session at 36 weeks, and may focus on addressing negative thought patterns and behaviours that contribute to the condition 6.
- GET for CFS typically involves a gradual increase in physical activity, with the goal of improving physical function and reducing fatigue 6.
- Adaptive pacing therapy for CFS involves helping patients to pace their activities in order to avoid exacerbating their symptoms, but has been found to be less effective than CBT and GET 4.
Effectiveness of Treatment
- Studies have shown that CBT and GET can be effective in reducing fatigue and improving physical function in patients with CFS, with response rates ranging from 30-60% 4, 5.
- Exercise therapy has also been shown to be effective in reducing fatigue and improving physical function in patients with CFS, with studies showing that it can be safely added to standard medical care 3.
- The effectiveness of adaptive pacing therapy for CFS is less clear, with some studies suggesting that it may be less effective than CBT and GET 4.