From the Guidelines
Chronic Fatigue Syndrome (CFS) patients should be managed with a multidisciplinary approach, including cognitive behavioral therapy, pacing activities, and gradual exercise within tolerance limits, as these interventions have shown to improve health function, health-related quality of life, or physical function 1. The management of CFS, also known as Myalgic Encephalomyelitis (ME), is complex and requires a comprehensive approach.
- A multidisciplinary approach is recommended, including pacing activities to avoid post-exertional malaise, gradual exercise within tolerance limits, and cognitive behavioral therapy to develop coping strategies.
- Cognitive behavioral therapy has been shown to be effective in improving health function, health-related quality of life, or physical function in patients with CFS, with multiple studies demonstrating significant improvements in these outcomes 1.
- Mindfulness-based therapies, such as yoga or tai chi, have also been found to be effective in reducing functional impairment and improving quality of life in patients with CFS, with moderate effect sizes compared to waitlist or support group controls 1.
- Medications may include low-dose antidepressants, pain relievers, and sometimes modafinil for severe fatigue, but the use of stimulants is not recommended due to insufficient evidence 1.
- Sleep hygiene and nutritional support are also crucial in managing CFS, with a focus on maintaining regular sleep hours, avoiding caffeine and screens before bed, and consuming anti-inflammatory foods, regular small meals, and staying well-hydrated.
- The underlying cause of CFS remains unclear, but it is likely to involve immune system abnormalities, viral triggers, and genetic factors, and recovery varies greatly between individuals, with some experiencing improvement over time while others have persistent symptoms requiring ongoing management.
From the Research
Definition and Diagnosis of Chronic Fatigue Syndrome
- Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue that is not relieved with rest and is associated with physical symptoms 2.
- The Centers for Disease Control and Prevention criteria for CFS include severe fatigue lasting longer than six months, as well as presence of at least four of the following physical symptoms: postexertional malaise; unrefreshing sleep; impaired memory or concentration; muscle pain; polyarthralgia; sore throat; tender lymph nodes; or new headaches 2.
- CFS is a clinical diagnosis that can be made only when other disease processes are excluded 2.
Etiology of Chronic Fatigue Syndrome
- The etiology of CFS is unclear, is likely complex, and may involve dysfunction of the immune or adrenal systems, an association with certain genetic markers, or a history of childhood trauma 2.
- CFS may be triggered by certain viruses in some patients, and neurobiological changes such as hypocortisolism are associated with the syndrome 3.
- A multifactorial cognitive behavioural model proposes that CFS is precipitated by life events and/or viral illness in vulnerable individuals, such as those who are genetically predisposed, prone to distress, high achievement, and over or under activity 3.
Treatment Options for Chronic Fatigue Syndrome
- Treatment options for CFS include cognitive behavior therapy (CBT) and graded exercise therapy, both of which have been shown to moderately improve fatigue levels, work and social adjustment, anxiety, and postexertional malaise 2, 3.
- Exercise therapy, including aerobic and anaerobic exercise, has been shown to reduce fatigue and improve physical functioning in adults with CFS 4.
- Isometric yoga has been shown to improve fatigue and pain in patients with CFS who are resistant to conventional therapy 5.
- Modafinil, when prescribed over the medium term, may be a potentially useful potentiating agent when added to CBT for treatment-resistant CFS 6.
Comparison of Treatment Options
- Exercise therapy may make little or no difference to fatigue at end of treatment compared to CBT 4.
- Exercise therapy may slightly reduce fatigue at end of treatment and at long-term follow-up compared to adaptive pacing 4.
- The available evidence suggests that there may be little or no difference between exercise therapy and CBT in physical functioning or sleep, and probably little or no difference in the effect on depression 4.