Criteria For Diagnosing Me/cfs
To be diagnosed with ME/CFS, you must have all of these symptoms:footnote 1
- Major decrease in your ability to do the things you did before you got sickincluding work, school, social, or personal activitiesthat has continued for more than 6 months.
- Worsening of symptoms after being mentally or physically active .
- Sleep problems, including not feeling rested after sleeping .
- Extreme fatigue that is:
- New or has not been a life-long problem.
- Not caused by being active for a long period of time.
- Not much better after resting.
You must also have one or more of these symptoms:
- Problems with concentration, short-term memory, or using the correct word .
- Feeling dizzy or faint while standing or sitting upright that gets better when you lie down .
Pragmatic Rehabilitation: The Fine Trial
Pragmatic rehabilitation is a programme involving gradually increasing activity designed collaboratively by the patient and the therapist. In response to an earlier successful trial, a larger trial was conducted. In this trial, patients fulfilling 1991 Oxford CFS criteria who were allocated to pragmatic rehabilitation reported a statistically significant though clinically modest improvement in fatigue compared with patients allocated to either supportive listening or treatment as usual, but after 12 months followup the differences were no longer statistically significant nor was there was any significant improvement in physical functioning at any time. About 10% of the trial participants were nonambulatory and about 30% met 1994 London criteria for ME, but separate results for these groups were not published . An accompanying editorial gave some possible reasons for the failure to replicate the earlier success in this trial, and called for further research. The patients in this trial had higher comorbidity and disability than patients in the earlier trial and in most other trials, and received fewer sessions than most successful trials of CBT and GET. The editorial also raised the question of whether generalists are as successful as specialists in offering behavioural interventions .
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Treatment Plans For Me/cfs
Theres no single way of managing ME/CFS that works for everyone, but there are a number of treatment options.
The National Institute for Health and Care Excellence says you should be offered a treatment plan tailored to your symptoms.
Your doctor should discuss all of the options with you, and explain the benefits and risks of any treatment.
They should work with you to develop a treatment plan that suits you and takes into account your circumstances and preferences.
You may need advice about making lifestyle changes, specialist treatments, or a combination of both.
If your symptoms are severe, your doctor should ask a specialist for advice.
Your treatment plan should be reviewed regularly.
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What Should I Keep In Mind While Taking Medications For Fatigue
Some of the considerations to keep in mind during treatment for chronic fatigue syndrome include:
- Take your medications exactly as directed. Do not take a larger or smaller dose or take the medicine more or less frequently than prescribed.
- Contact your doctor if the side effects are severe or do not go away.
- Talk to your doctor before stopping any medication.
- Do not use someone elses prescription medication or share yours with others.
- Give your doctor a complete list of your medications, including prescription medications, over-the-counter products, and herbal supplements to help avoid drug interactions.
Alternative Or Complementary Medicine
Since there is no standard treatment for CFS/ME, people often consider alternatives to traditional medicine or use non-traditional treatments to complement their other medications. Commonly used alternative and complementary treatments include:
- Mind-body treatments, like qigong, tai chi, and meditation
- Massage
- Trigger point therapy, called myofascial release
- Acupuncture
- Chiropractic treatments
Complementary therapies have received mixed results when scientifically studied. Before beginning an alternative or complementary treatment, talk with your doctor to ensure that you arent trying something potentially dangerous.
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How Is Me/cfs Treated
There isn’t a cure yet for ME/CFS. So the keys to living with ME/CFS are learning how to pace your activities and treating your symptoms.
There are some things you can do to treat the most common symptoms.
- For symptoms that are worse after activity , learn how to manage your activity. Think about how much energy you have on a given day and try not to “spend” more than you have.
- If you feel dizzy or weak while sitting or standing, you can try wearing pressure stockings or putting your feet up. Or your doctor may recommend eating more salt or taking certain medicines.
- Sleep problems may improve with better sleep habits. You can also ask your doctor how medicines can help.
- Pain can be treated with over-the-counter medicines. Some prescription medicines may also help.
- If you’re feeling depressed, talk to your doctor.
Try Exercising When You Can
As a person with ME/CFS, youve also probably experienced post-exertional malaise. This can be triggered by even small amounts of exercise.
But if youre able to, safely incorporating small amounts of exercise into your life can help reduce symptoms.
This can be something low-impact and simple, like walking, tai chi, and yoga. Just remember to start small and increase the length and intensity of your workouts slowly over time.
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How Can I Overcome Chronic Fatigue
How can I overcome chronic fatigue? 4 Steps to OvercomeChronicFatigue Syndrome Step 1: Eliminate Food Sensitivities and Allergens Step 2: Increase Your Vitamin B Intake Step 3: Increase Potassium and Magnesium Intake Step 4: Build Peace and Relax
What is the cure for chronic fatigue? There is no cure for chronic fatigue syndrome, so treatment is aimed at managing symptoms. Treatment usually involves a combination of medication and lifestyle changes such as preventing overexertion, reducing stress, managing diet, and nutritional supplements.
What are the best supplements for chronic fatigue? The following specific supplements can support the activities of the immune system and adrenal glands and are, therefore, frequently prescribed to people with chronic fatigue syndrome: vitamin C. beta-carotene. pantothenic acid zinc. magnesium adrenal extract.
What causes extreme fatigue? Infections especially viral infections are among the leading causes of extreme fatigue. Common, short-term viral illnesses associated with extreme fatigue include influenza and infectious mononucleosis. Other possibilities include viral hepatitis, Lyme disease and HIV/AIDS.
Concluding Remarks And Future Directions
This review suggests that the beneficial effects of nutritional supplements are not random, but that their action is due to the removal of one of the causes of the CFS/ME. There is evidence that supplements may benefit CFS/ME patients therefore, nutritional supplements should be recommended, at least in CFS/ME patients with a biochemically proven deficiency. Studies investigating nutritional interventions in CFS/ME remain very limited most studies have had small sample sizes, and lacked long term followup . Despite the relative consistency in case definition, the studies differed with regard to inclusion and exclusion criteria and reporting participants’ sociodemographic characteristics and clinical features . This heterogeneity in study design makes the application of the findings to the clinical setting more difficult. Therefore, longerterm RCTs in homogeneous populations that use more specific case criteria are now warranted.
In agreement with several previous studies, pacing was consistently shown to be the most helpful treatment, CBT was useful for some patients but not all for all graded training may cause the condition to worsen. However, the results must be interpreted with care, as the participants are not a representative sample.
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Central Nervous System Stimulants May Be Helpful
in Chronic Fatigue Syndrome and fibromyalgia because they increase alertness, concentration, motivation and energy and can assist with circulatory problems. One study suggests they may be able to help with fatigue and pain as well.
Plus, the disorder stimulants are most commonly used in attention hyperactivity deficit disorder appears to be common in fibromyalgia and probably ME/CFS. One study which employed an ADHD self-test found that almost 50% of FM patients tested positive for ADHD.
Therapy For Fatigue: Case Example
Co-occurring fatigue and depression: Benjamin, 46, has been feeling constantly tired for months. His fatigue is getting to the point where he cannot focus on his work and is too tired to participate in social events he used to enjoy. He has tried getting more sleep at night, but no matter how much sleep he gets, his energy during the day does not seem to improve. Looking for answers, Benjamin set up an appointment with his medical doctor, but none of the tests done on him indicate a direct medical cause. Upon hearing about Benjaminâs loss interest in activities he used to enjoy and difficulty focusing at work, his doctor refers him to a therapist. After speaking with his therapist, Benjamin is diagnosed with depression. He learns that much of his fatigue seems to be due to his depression. By taking daily nature walks, meditating, and talking with his therapist, Benjamin learns how to effectively cope with and minimize his depression, and his energy slowly begins to return.
References:
- Client referrals
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When To Call A Doctor
It’s important to talk to your doctor about any symptoms you may have.
- Severe fatigue that lasts longer than 2 weeks, causes you to limit your usual activities, and does not improve with rest.
- Sleep problems that last for more than 1 to 2 months. These problems may include being unable to fall asleep or stay asleep, tossing and turning, and waking up feeling tired or not rested.
- Swelling in the glands in your neck or armpits that lasts for at least 2 weeks.
- Severe fatigue along with frequent urination , extreme thirst, weight loss, or blurred vision. Fatigue that occurs with some or all of these may be a symptom of undiagnosed diabetes.
- Severe headache that does not improve with home treatments.
What Happens If I Overdose
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of amantadine can be fatal.
Overdose symptoms may include confusion, agitation, behavior changes, hallucinations, severe headache or pounding in your ears, muscle stiffness, problems with balance or walking, trouble breathing, fast heartbeats, or seizure.
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How Cbd Oil Works To Help With Chronic Fatigue Syndrome
To understand how CBD may help with chronic fatigue syndrome, one must first learn how the endocannabinoid system operates.
The ECS, a system present in all mammals, is responsible for maintaining various bodily functions. It regulates the physiological functions in an individual by way of its receptors.
A 2018 review stated that CBD had shown neuroprotective properties based on how it interacted directly with the ECS and its receptors. It also mentioned that CBD might help relieve depression, anxiety, and inflammation.
The CB1 and CB2 structures are the most prominent receptors in the endocannabinoid system, with each having different roles.
The CB1 cannabinoid receptors are believed to influence pain sensation, mood, sleep, appetite, memory processing, and motor regulation.
Activating the CB1 receptors has been associated with neuroprotective responses that could potentially benefit people with conditions, like multiple sclerosis and Alzheimers disease.
On the other hand, CB2 receptors are present mainly on cells in the immune system of the body. When activated, they cause a response that combats inflammation, potentially reducing pain and damage to tissues.
Cannabinoids, which are chemicals naturally produced by the human body, are designed to interact with CB1 and CB2 receptors to maintain balance.
Scientists learned that phytocannabinoids, which are primarily obtained from plants, like Cannabis sativa, also effectively stimulates these receptors.
How Is Cfs Treated
Theres currently no specific cure for CFS.
Each person has different symptoms and therefore may require different types of treatment to manage the disorder and relieve their symptoms.
Work with your team of healthcare providers to create the best treatment plan for you. They can go over the possible benefits and side effects of the therapies with you.
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Treatment Of Neurally Mediated Hypotension
Orthostatic intolerance has been observed frequently in patients with CFS. It is 1 of the symptoms included in the new IOM SEID diagnostic criteria. These specific criteria include more than 6 months of debilitating fatigue, post-exertional malaise, and unrefreshing sleep, as well as cognitive impairment and/or orthostatic intolerance.
Evidence for orthostatic intolerance has included abnormal cardiac response to standardized laboratory stimuli, particularly rapid standing and exercise.³ However, such abnormalities are inversely related to the subjects overall fitness. The heart rate dynamic response during the head-up tilt test has been especially helpful to distinguish patients with CFS from healthy controls.
In an earlier, uncontrolled trial, 22 of 23 CFS patients had abnormal tilt testing and were treated with increasing doses of the corticosteroid fludrocortisone, the beta-blocker atenolol, and the antiarrhythmic disopyramide.³ Most of the patients reported marked relief of symptoms following treatment. The same investigators found similar positive outcomes in a follow-up trial of subjects with CFS and FM, but neither of these trials was controlled.
Exercise And Multidisciplinary Therapy
Most clinicians understand the benefits of exercise, even for patients with chronic pain. But what are the for patients with CFS? What type, duration, and intensity level is recommended? To answer some of these questions, a Cochrane review evaluated 8 RCTs of exercise in 1,518 CFS subjects.¹ The authors concluded that patients with CFS may generally benefit and feel less fatigued following exercise therapy. There was no evidence that exercise therapy worsened outcomes.
The most common intervention used structured, incremental increase in aerobic exercise over time . Seven of these trials showed a positive effect on fatigue. A variety of land- and water-based exercise programs of varying time and intensity were used. In general, exercise also improved sleep, physical function, and self-perceived general health. The retrospective review was unable to look at what effect exercise had on pain, quality of life, mood, or health service resources. The authors concluded that the efficacy of exercise therapy was greater than that of pacing and similar to that of CBT. There were no significant adverse effects from exercise.
A combination of CBT and exercise may help both fatigue and neurocognition.²²²³ A 12-week graded activity program combined with CBT resulted in objective neurocognitive performance improvement.²³
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What Are The Treatments For Chronic Fatigue Syndrome
There is no cure or approved treatment for CFS, but you may be able to treat or manage some of your symptoms. You, your family, and your health care provider should work together to decide on a plan. You should figure out which symptom causes the most problems and try to treat that first. For example, if sleep problems affect you the most, you might first try using good sleep habits. If those do not help, you may need to take medicines or see a sleep specialist.
Strategies such as learning new ways to manage activity can also be helpful. You need to make sure that you do not “push and crash.” This can happen when you feel better, do too much, and then get worse again.
Since the process of developing a treatment plan and attending to self-care can be hard if you have CFS, it is important to have support from family members and friends.
Don’t try any new treatments without talking to your health care provider. Some treatments that are promoted as cures for CFS are unproven, often costly, and could be dangerous.
Centers for Disease Control and Prevention
Chronic Fatigue Syndrome Symptoms
While the term chronic fatigue is fairly descriptive of this crippling illness, it doesnt tell the entire story. Chronic fatigue often starts suddenly, with flu-like symptoms. But unlike the flu, it can last a lifetime.
In addition to the profound fatigue experienced, other serious symptoms often accompany CFS, such as:
- joint pain that moves from one spot to another
- muscle pain
- night sweats
- digestive disorders like irritable bowel syndrome .
Sufferers of chronic fatigue syndrome also experience significant alterations in levels of irritability, mood swings, panic attacks, anxiety and depression. According to a study published in Family Practice, 36 percent of individuals with CFS were clinically depressed and 22 percent had seriously considered suicide in the past year.
Simply, the emotional and mental side effects of CFS cannot be overlooked, and treatment must include the mind, body and spirit.
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Vitamin B12 And Folic Acid
Researchers have been exploring whether vitamin B12 injection or other means of supplementation, along with folic acid, can relieve CFS symptoms.
There is a biochemical theory as to how this may be of benefit: People with CFS show reduced methylation which plays a role in gene expression as well as regulation of many of the body’s systems, including detoxification, cardiovascular and the neurologic system. Vitamin B12 and folic acid both promote healthy methylation pathways.
A study of B12 injections in addition to oral folic acid supplementation found that some subjects with CFS responded well, while others had only a mild response. A better response was associated with more frequent injections, lack of use of opioids, and a certain genetic phenotype.
Another study looked at using B12 nasal drops as an alternative to injections in subjects with CFS. This study also found good response in two-thirds of the participants. The researchers demonstrated that those who had a better response had a higher blood level of B12 and were more physically active .
Memory And Concentration Problems
Memory aids, like organizers and calendars, can help with memory problems. For people with ME/CFS who have concentration problems, some doctors have prescribed stimulant medications, like those typically used to treat Attention-Deficit / Hyperactivity Disorder . While stimulants might help improve concentration for some patients with ME/CFS, they might lead to the push-and-crash cycle and worsen symptoms. Push-and-crash cycles are when someone with ME/CFS is having a good day and tries to push to do more than they would normally attempt .
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