From the Guidelines
The diagnosis and treatment of Myalgic Encephalomyelitis (ME), also known as Chronic Fatigue Syndrome (CFS), should prioritize cognitive-behavioral therapy (CBT) as the primary treatment approach, as it has shown significant improvement in health function, health-related quality of life, or physical function in patients with ME/CFS, as supported by a systematic review and multiple clinical trials 1.
Diagnosis
The diagnosis of ME/CFS is complex and involves a comprehensive evaluation of the patient's symptoms, medical history, and physical examination. The condition is characterized by extreme fatigue that doesn't improve with rest and worsens with physical or mental activity.
Treatment
The treatment of ME/CFS focuses on symptom management, as there is no cure. The following approaches can be considered:
- Cognitive-behavioral therapy (CBT): CBT has the greatest evidence supporting its use in ME/CFS, with multiple studies consistently finding significant improvement in health function, health-related quality of life, or physical function 1.
- Mindfulness-based therapies: Mindfulness-based therapies, such as mindfulness-based stress reduction and meditation awareness training, have also shown promise in improving symptoms in patients with ME/CFS, although the evidence is not as strong as for CBT 1.
- Paced activity: Paced activity, which involves balancing activity with rest to avoid post-exertional malaise, can help patients manage their symptoms and improve their quality of life.
- Medications: Medications such as low-dose antidepressants, pain relievers, and modafinil may be considered for symptom management, although the evidence for their effectiveness is limited.
- Lifestyle modifications: Lifestyle modifications, including maintaining good sleep hygiene, gentle stretching or yoga, and nutritious eating, are crucial in managing symptoms and improving quality of life.
Important Considerations
- Avoid overexertion: Patients with ME/CFS should avoid overexertion, as it can trigger symptom flares lasting days or weeks.
- Individualized treatment plans: Patients should work with healthcare providers to develop individualized treatment plans that take into account their unique needs and circumstances.
- Multidisciplinary approach: A multidisciplinary approach, involving healthcare providers from different specialties, can help patients receive comprehensive care and manage their symptoms effectively.
From the Research
Diagnosis of Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS)
- ME/CFS is characterized by persistent, medically unexplained fatigue, as well as symptoms such as musculoskeletal pain, sleep disturbance, headaches, and impaired concentration and short-term memory 2, 3, 4, 5, 6
- Diagnosis is based on operationalized diagnostic criteria, such as the 1994 criteria of the Centers for Disease Control and Prevention (CDC) or the Oxford criteria 2, 3, 5
Treatment of ME/CFS
- Exercise therapy has been shown to be effective in reducing fatigue and improving physical functioning in patients with ME/CFS 2, 3, 6
- Cognitive behavioral therapy (CBT) has also been found to be effective in reducing fatigue and improving physical functioning 4, 5
- Adaptive pacing therapy has been advocated by patient organizations, but lacks empirical support 5
- Graded exercise therapy has been found to be effective in reducing fatigue and improving physical functioning, but may be less acceptable to patients than other management approaches 6
- Pharmacological interventions, such as antidepressants, have been found to be ineffective in reducing fatigue in patients with ME/CFS 6
Comparison of Treatments
- Exercise therapy has been found to be more effective than adaptive pacing therapy in reducing fatigue and improving physical functioning 2, 3
- CBT has been found to be similar in effectiveness to exercise therapy in reducing fatigue and improving physical functioning 2, 3
- The combination of exercise therapy and CBT has been found to be more effective than exercise therapy alone in reducing fatigue and improving physical functioning 6