From the Guidelines
The most effective treatment options for Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS) include cognitive-behavioral therapy (CBT) and mindfulness-based therapies, which have shown significant improvements in health function, health-related quality of life, and physical function. These therapies should be considered as first-line treatments for patients with ME/CFS, as they have been found to be effective in reducing symptoms and improving quality of life 1.
Non-Pharmacological Interventions
- CBT: helps patients develop coping strategies and address thoughts and behaviors that may worsen symptoms
- Mindfulness-based therapies: have been found to reduce functional impairment and improve quality of life
- Pacing activities: to avoid post-exertional malaise, which is a common symptom of ME/CFS
- Sleep hygiene practices: to improve sleep quality and duration
- Nutritional support: focusing on a balanced diet, with some patients reporting benefits from eliminating certain foods that trigger symptoms
Pharmacological Interventions
- There is insufficient evidence to recommend for or against offering duloxetine for patients with CMI and symptoms consistent with myalgic encephalomyelitis/chronic fatigue syndrome 1
- We recommend against offering stimulants for treatment of fatigue in patients with CMI and symptoms consistent with myalgic encephalitis/chronic fatigue syndrome 1
- Other medications, such as amitriptyline, trazodone, and pregabalin, may be considered for specific symptoms, such as sleep disturbances and pain management
Additional Considerations
- Treatment should be individualized, as ME/CFS presents differently in each person
- Regular follow-up with healthcare providers is essential to adjust the treatment plan as needed
- Patients may benefit from addressing orthostatic intolerance with increased salt and fluid intake, compression stockings, or medications like fludrocortisone (0.1-0.2mg daily) 1
- Some patients may benefit from alternative therapies, such as yoga or tai chi, which have been found to improve physical functioning and quality of life 1
From the Research
Treatment Options for Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS)
- The main evidence-based treatments for ME/CFS are rehabilitative in nature and include:
- These treatments have been shown to be effective in reducing fatigue, improving physical function, and enhancing overall health 6, 2, 3, 4, 5
- CBT and GET have been found to be equally effective in decreasing fatigue, anxiety, and depression, and in increasing physical functioning 3
- A shorter, interpersonal oriented cognitive behavioral therapy (I-CBT) has also been shown to improve physical function in patients with mild to moderate CFS 5
- Exercise therapy has been found to be beneficial in reducing fatigue, improving sleep, and enhancing self-perceived general health 6
- The effectiveness of pharmaceutical interventions is still unclear due to limited evidence 6, 4
Key Findings
- CBT and GET are recommended as the primary treatments for ME/CFS 2, 4
- These treatments should be preceded by a thorough clinical assessment and delivered by appropriately trained therapists working in close collaboration with the patient 2
- The treatment outcome and metacognitive change in CBT and GET for CFS have been found to be significant, with changes on subscales of the Metacognitions Questionnaire-30 (MCQ-30) predicting fatigue severity independently of changes in other covariates 3
- A consecutive randomized controlled trial found that standard CBT and a shorter I-CBT can improve physical function and fatigue in patients with mild to moderate CFS 5
Safety and Effectiveness
- CBT and GET have been found to be safe and effective in improving fatigue and physical function in patients with ME/CFS 6, 2, 3, 4, 5
- No serious adverse reactions were recorded in any of the groups during the trial period 5
- The positive change in physical function persisted at 1-year follow-up for both treatment groups, and for standard CBT also in fatigue 5