From the Guidelines
Chronic Fatigue Syndrome (CFS) treatment should prioritize cognitive-behavioral therapy and pacing to manage symptoms, as these approaches have shown significant improvement in health function and quality of life, according to the most recent and highest quality study 1.
Development Mechanisms
CFS, also known as Myalgic Encephalomyelitis (ME), develops through a complex interplay of factors including viral infections, significant stress, or immune system dysfunction, which cause persistent changes in the body's immune response, energy metabolism, and neurological function [ 1 ]. Genetic predisposition likely plays a role, as some individuals seem more susceptible to developing CFS following these triggers.
Treatment Options
Treatment for CFS focuses on symptom management rather than cure. A personalized approach works best, typically including:
- Paced activity management to avoid post-exertional malaise [ 1 ]
- Cognitive-behavioral therapy to develop coping strategies and improve physical functioning [ 1 ]
- Medications such as low-dose naltrexone (3-4.5mg daily) for pain and fatigue [ 1 ]
- Addressing sleep hygiene, nutrition, and gentle exercise within tolerance limits
The use of stimulants for treatment of fatigue in patients with CFS is not recommended, as stated in the 2021 US Department of Veterans Affairs and US Department of Defense clinical practice guideline [ 1 ]. It is essential for patients to work closely with healthcare providers to adjust treatments based on their specific symptoms, as the condition fluctuates over time and no single treatment works for everyone.
From the Research
Development Mechanisms of Chronic Fatigue Syndrome (CFS)
- The precise etiology of CFS remains unknown, but recent advances and research discoveries are beginning to shed light on the enigma of this disease, including infectious, genetic, immune, cognitive, sleep, metabolic, and biochemical abnormalities 2.
- Viral infection is an established trigger for the onset of CFS symptoms, raising the possibility of an increase in CFS prevalence resulting from the ongoing COVID-19 pandemic 3.
- The immunological pattern of CFS patients indicates that the immune system is chronically activated, and genetic features of patients are studied to evaluate their role in triggering the pathology 4.
- Common features of CFS include immune dysregulation and mitochondrial dysfunction, but the underlying mechanistic basis of the disease remains poorly understood 3.
Treatment Options for Chronic Fatigue Syndrome (CFS)
- Current treatments are largely palliative and limited to alleviating symptoms and addressing the psychological sequelae associated with long-term disability 3.
- The main evidence-based treatments are rehabilitative in nature and include specific types of cognitive behavior therapy (CBT) and graded exercise therapy (GET) 5.
- Pacing of activities with strategic rest periods is considered an important coping strategy for patients to better manage their illness and stop their post-exertional fatigue and malaise 2.
- Treatment programs are directed at relief of symptoms, with the goal of the patient regaining some level of preexisting function and well-being 4.
- Cognitive behavioural therapy is of benefit to a small percentage of patients (8%-35%), while pacing is the most favoured treatment with the lowest negative response rate and the highest reported benefit (44%-82%) 6.
- Graded exercise therapy brings about large negative responses in patients (54%-74%), highlighting the need for careful consideration and personalized treatment approaches 6.