From the Guidelines
Treatment for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) should prioritize cognitive-behavioral therapy and mindfulness-based therapies as first-line non-pharmacological approaches, as they have shown significant improvement in health function, health-related quality of life, or physical function in patients with ME/CFS, as supported by the 2022 Mayo Clinic Proceedings study 1.
Key Recommendations
- Cognitive-behavioral therapy is recommended for patients with ME/CFS, as it has been shown to improve physical functioning and health-related quality of life 1.
- Mindfulness-based therapies, such as mindfulness-based stress reduction and meditation awareness training, are also recommended for patients with ME/CFS, as they have been shown to reduce functional impairment and improve quality of life 1.
- Pacing activities to avoid post-exertional malaise, gentle exercise within tolerance limits, and stress management techniques like meditation are equally important non-pharmacological approaches.
- Medications such as low-dose naltrexone, duloxetine, or amitriptyline may be considered for pain management, while melatonin or trazodone may be used for sleep problems.
Lifestyle Modifications
- Maintaining good sleep hygiene, eating a balanced diet, and staying hydrated are essential for managing ME/CFS symptoms.
- Patients should work closely with healthcare providers to develop an individualized treatment plan that addresses their specific symptoms and adjusts as needed.
Complementary and Integrated Health Interventions
- Yoga or tai chi and manual acupuncture may be considered as complementary and integrative health interventions for patients with ME/CFS, as they have shown benefits in reducing symptoms and improving quality of life 1.
From the Research
Treatment Options for Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS)
- The treatment options for ME/CFS include mind-body interventions (MBIs), cognitive behavioral therapy (CBT), graded exercise therapy (GET), and pacing therapy 2, 3, 4, 5, 6.
- MBIs, such as mindfulness-based stress reduction and acceptance and commitment therapy, have been shown to improve fatigue severity, anxiety/depression, and quality of life in patients with ME/CFS 2.
- CBT and GET are often promoted as evidence-based treatments for ME/CFS, but their effectiveness and safety have been questioned by some studies 3, 5.
- Pacing therapy, which involves pacing activities with strategic rest periods, is a coping strategy that can help patients manage their illness and reduce post-exertional fatigue and malaise 3, 4.
- A patient-centered care approach that begins with the symptoms that are most troublesome for the patient is recommended for managing ME/CFS 4.
Effectiveness of Different Therapies
- CBT has been shown to be beneficial for a small percentage of patients (8%-35%), while GET has been found to bring about large negative responses in patients (54%-74%) 3.
- Pacing therapy has been found to be the most favored treatment with the lowest negative response rate and the highest reported benefit (44%-82%) 3.
- MBIs have been shown to improve fatigue severity, anxiety/depression, and quality of life in patients with ME/CFS, but the evidence is limited by small sample sizes and heterogeneous diagnostic criteria 2.
Importance of Patient-Centered Care
- A thorough clinical assessment and delivery of rehabilitative treatment by appropriately trained therapists working in close collaboration with the patient is recommended 6.
- Patient-centered care that takes into account the individual needs and symptoms of each patient is essential for effective management of ME/CFS 4, 6.