From the Guidelines
Treating chronic fatigue, particularly in the context of myalgic encephalomyelitis/chronic fatigue syndrome, should primarily involve cognitive-behavioral therapy, as it has shown significant improvement in health function, health-related quality of life, or physical function in patients with chronic multisymptom illness (CMI) 1.
Key Recommendations
- Cognitive-behavioral therapy is recommended due to its strong evidence base, including a meta-analysis of 29 studies that found 44.3% of participants in the cognitive-behavioral therapy arms improving 20% or more on health-related quality of life compared with 31.5% of participants in the control arms 1.
- Mindfulness-based therapies also have strong evidence supporting their use for patients with CMI and symptoms consistent with fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), with improvements seen in functional impairment and quality of life 1.
- Exercise, such as aerobic exercise, can be beneficial when combined with cognitive-behavioral therapy, but the evidence for its standalone use is less clear 1.
Medication Considerations
- Stimulants are not recommended for the treatment of fatigue in patients with CMI and symptoms consistent with ME/CFS due to insufficient evidence 1.
- The use of duloxetine for patients with CMI and symptoms consistent with ME/CFS is not recommended for or against due to insufficient evidence 1.
Lifestyle Modifications
- Establishing a consistent sleep schedule and practicing good sleep hygiene are crucial for managing fatigue.
- Gradually increasing physical activity with low-impact exercises can help improve tolerance and reduce fatigue.
- Eating regular, balanced meals and limiting processed foods, sugar, and caffeine can also play a role in managing fatigue.
- Stress management techniques such as meditation, deep breathing, or yoga can help reduce fatigue and improve overall well-being.
From the Research
Treatment Options for Chronic Fatigue
- A structured plan for regular physical activity, including stretching and aerobic exercise, such as walking, is recommended for treating chronic fatigue 2.
- Cognitive behavior therapy may be effective in managing chronic fatigue syndrome 2, 3.
- Medications such as selective serotonin reuptake inhibitors (e.g., fluoxetine, paroxetine, or sertraline) may improve energy in patients with depression and chronic fatigue 2.
- Modafinil, a central nervous system stimulant, has been shown to improve fatigue symptoms in patients with inflammatory bowel disease and chronic fatigue 4.
- Vitamin B12 injections, in combination with oral folic acid, may be beneficial for patients with myalgic encephalomyelitis (also known as chronic fatigue syndrome) 5.
Lifestyle Modifications
- Getting regular sleep and avoiding excessive caffeine and alcohol consumption can help manage chronic fatigue 2.
- Short naps can be beneficial for improving performance and reducing fatigue 2.
- Avoiding strenuous activities and pacing oneself can help prevent post-exertion malaise, a common symptom of chronic fatigue syndrome 6, 3.
Diagnostic Considerations
- Chronic fatigue syndrome is a diagnosis of exclusion, and other medical and psychiatric conditions must be ruled out before making a diagnosis 6, 3.
- A comprehensive diagnostic evaluation, including laboratory tests and physical examination, is necessary to identify underlying causes of chronic fatigue 2, 6.
- The Centers for Disease Control and Prevention (CDC) recommends a diagnostic criteria that includes self-reported fatigue for at least six months and four of the following symptoms: memory problems, sore throat, post-exertion malaise, tender cervical or axillary lymph nodes, myalgia, multi-joint pain, headaches, and troubled sleep 3.