(Krilov et al., 1998). Many of the symptoms of CFS and CFS-like illness (meeting some but not all of the criteria for CFS) are similar to those experienced by people who have CMI. Both CMI and CFS include a variety of symptoms—fatigue, cognitive symptoms, and pain.
Treatments for Chronic Fatigue Syndrome
Both US and UK treatment guidelines emphasize the lack of a particular medication or therapy to cure CFS. However, an individualized treatment program and a patient-centered care model to tailor symptom management to a patient’s needs are recommended. Symptoms of CFS may be managed in primary care (CDC, undated; Mayo Clinic staff, 2011; National Collaborating Centre for Primary Care, 2007).
Two specific therapies are recommended for people who have CFS: CBT and graded exercise therapy (GET) (CDC, 1994; Mayo Clinic staff, 2011; National Collaborating Centre for Primary Care, 2007). CBT provides a framework for patients to change how they think and feel about their illness and teaches behaviors that provide patients with a greater sense of control over symptoms (CDC, undated; National Collaborating Centre for Primary Care, 2007). Exercise has been associated with the body’s natural release of endorphins, natural pain relievers. Both exercise and endorphins have been shown to improve a number of the symptoms of CFS and related syndromes (Cleare, 2003; Harber and Sutton, 1984).
Additional CFS management strategies can be recommended to improve quality of life. Pacing to balance activities and rest throughout the day may be helpful to avoid “crashing” after too much activity; however, evidence is insufficient to determine efficacy (CDC, 1994; National Collaborating Centre for Primary Care, 2007). Disturbance of restorative or deep sleep may play a role in triggering symptoms of CFS (Moldofsky, 1993). Sleep patterns should be changed gradually to introduce a regular sleeping schedule, bedtime routine, noise and light control, and avoidance of caffeine, alcohol, and tobacco (CDC, 1994; National Collaborating Centre for Primary Care, 2007). Clinicians should also encourage patients to learn coping skills through counseling and support groups and to maintain their independence as much as possible (CDC, 1994; Mayo Clinic staff, 2011).
Management may focus on treating specific symptoms. Drug therapy is recommended to manage some symptoms, but clinicians are encouraged to use as few drugs as possible and to use minimal doses because people who have CFS are often more sensitive to medications. Pain may be managed with acetaminophen, aspirin, or NSAIDs, but narcotics are not recommended. Sleep medications or treatments, such as melatonin and continuous positive airway pressure, may be useful if indicated by the patient’s history and improvements are not seen with good sleep hygiene