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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How Is Chronic Fatigue Syndrome Treated
Treatment is determined by your healthcare provider and based on:
- Your overall health and medical history
- Extent of the condition
- Your tolerance for specific medicines, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
- Medicine, including corticosteroids, antidepressants, and others
- Light-intensity aerobic exercise
- Dietary supplements and herbal preparations
- Psychotherapy and supportive counseling
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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What You Can Do
Before your appointment, you may want to write a list that includes:
- Your signs and symptoms. Be thorough. While fatigue may be affecting you most, other symptoms â such as memory problems or headaches â also are important to share with your doctor.
- Key personal information. Recent changes or major stressors in your life can play a very real role in your physical well-being.
- Health information. List any other conditions for which youâre being treated and the names of any medications, vitamins or supplements that you take regularly.
- Questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.
For chronic fatigue syndrome, some basic questions to ask your doctor include:
- What are the possible causes of my symptoms or condition?
- What tests do you recommend?
- If these tests donât pinpoint the cause of my symptoms, what additional tests might I need?
- On what basis would you make a diagnosis of chronic fatigue syndrome?
- Are there any treatments or lifestyle changes that could help my symptoms now?
- Do you have any printed materials I can take with me? What websites do you recommend?
- What activity level should I aim for while weâre seeking a diagnosis?
- Do you recommend that I also see a mental health provider?
Donât hesitate to ask other questions during your appointment as they occur to you.
What Complications Are Associated With Myalgic Encephalomyelitis/chronic Fatigue Syndrome
For some people, the fatigue associated with ME/CFS makes activities of daily living very difficult or even impossible. Research shows that only half of all people diagnosed with ME/CFS work full-time or part-time jobs.
ME/CFS causes significant depression in many people living with the condition. If you experience depression, talk with your doctor â effective treatments are available.
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Coenzyme Q10 Plus Nadh And Mitochondrial Dysfunction
Coenzyme Q10 and NADH are common antioxidant supplements that have been used for several decades as dietary supplements for general maintenanceof health. The benefits of their administration have been extensively evaluated in several conditions . However, several studies have shown that there is a mitochondrial dysfunction, which reduces the ATP production, as an immediate effect primary or secondary to symptoms in most CFS/ME patients .
In the UK, Myhill et al. highlighted the power and usefulness of the ATP profile test as a diagnostic tool for differentiating between patients who have CFS/ME and other symptoms as a result of energy wastage due to stress and psychological factors and those who have insufficient energy due to cellular respiration dysfunction. The biochemical tests should be performed in CFS/ME patients before and after appropriate interventions, and possibly in other disabling fatigue conditions as well .
Relatively few pharmacological or other therapies for CFS/ME have been tested in large RCTs. Overall, a report commissioned by the AHRQ based on a systematic review for a US NIH Pathways to Prevention Workshop concluded that no available pharmacotherapy is of proven benefit in CFS/ME. Table 1 summarizes the current drug therapeutic strategies for CFS/ME.
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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What To Expect At Your Provider’s Office
There is no laboratory test for chronic fatigue syndrome. But your health care provider may use tests to rule out other illnesses. Your provider will go over your symptoms, check your medical history, and do a physical examination.
If you have CFS, your provider may prescribe drugs to treat your symptoms, or suggest herbs, vitamins, or dietary changes to help you. Get plenty of rest, exercise regularly, and learn to pace yourself. Often this combination of treatments will help you get better.
If the usual treatments do not work, your provider may check for other conditions that can cause symptoms similar to those of CFS.
Preparing For An Appointment
If you have signs and symptoms of chronic fatigue syndrome, you’re likely to start by seeing your family doctor or a general practitioner. It can be difficult to absorb all of the information provided during an appointment, so you might want to arrange for a friend or family member to accompany you. Having someone else hear the information can help you later in case there’s something you missed or forgot.
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Nice Has Today Published Its Updated Guideline On The Diagnosis And Management Of Myalgic Encephalomyelitis /chronic Fatigue Syndrome
28 October 2021
It is estimated that there are over 250,000 people in England and Wales with ME/CFS, with about 2.4 times as many women affected as men.
The guideline covers every aspect of ME/CFS in children, young people and adults from its identification and assessment before and after diagnosis to its management, monitoring and review.
Paul Chrisp, director of the Centre for Guidelines at NICE, said:As well as bringing together the best available scientific evidence, weve also listened to the real, lived experience and testimony of people with ME/CFS to produce a balanced guideline which has their wellbeing at its heart. NICE hopes that system partners and the ME/CFS community will work together to make sure these important recommendations are implemented.
Peter Barry, Consultant Clinical Advisor for NICE and chair of the guideline committee, said: This guideline will provide clear support for people living with ME/CFS, their families and carers, and for clinicians. It recognises that ME/CFS is a complex, chronic medical condition that can have a significant effect on peopleâs quality of life.
People with ME/CFS should receive individually tailored support focused on personal agreed goals and a range of approaches should be used depending on the patientâs preferences and priorities.
Diagnostic Criteria For Me/cfs Using The National Academy Of Medicine Clinical Criteria
For a diagnosis of ME/CFS, the person must have the following three symptoms:
Diagnosis also requires at least one of the following two symptoms:
It is important to note that these are not the only symptoms of ME/CFS, just the minimum needed to meet the diagnostic criteria.
While diagnosis requires that a person has had symptoms continually for six months, early intervention with pacing and rest can help reduce symptoms, improve quality of life and reduce the risk of exacerbating the disease. Research suggests that patients who are able to pace their activity and not push themselves tend to do better in the long term. Pacing and rest can start even prior to an official diagnosis.
While there is currently no cure and no evidence-based treatments, it is important to find a doctor who is not only sympathetic to ME/CFS, but can work with you to help manage your symptoms.
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What Is The Outlook
The long-term outlook for chronic fatigue syndrome varies from person to person. Although some people recover or have a long period of remission, many will need to adapt to living with /CFS. The outlook is better in children and young people than in adults.
Chronic fatigue syndrome affects everyone differently and its impact varies widely. For some people symptoms still allow them to carry out some activities, whereas for others they cause severe impacts on different aspects of the lives of people with CFS and their families and carers, including activities of daily living, family life, social life, emotional well-being, work and education.
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 âpush and crash.â 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.
Donât 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
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What To Expect At Your Providers Office
There is no laboratory test for chronic fatigue syndrome. But your health care provider may use tests to rule out other illnesses. Your provider will go over your symptoms, check your medical history, and do a physical examination.
If you have CFS, your provider may prescribe drugs to treat your symptoms, or suggest herbs, vitamins, or dietary changes to help you. Get plenty of rest, exercise regularly, and learn to pace yourself. Often this combination of treatments will help you get better.
If the usual treatments do not work, your provider may check for other conditions that can cause symptoms similar to those of CFS.
The Benefit Of Treatment For Chronic Fatigue Syndrome
For those unfamiliar with fatigue, it is often misinterpreted or dismissed by those who have never experienced it. People who suffer from exhaustion may find it difficult to carry out everyday tasks, resulting in a lower quality of life. CFS/ME rehabilitation is the emphasis of our treatment program, which uses a holistic approach to assist our patients in making and retaining gains over time and living a fulfilling life.
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How Is Myalgic Encephalomyelitis/chronic Fatigue Syndrome Diagnosed
Your doctor diagnoses ME/CFS by performing a mental and physical examination. Doctors will ask about your medical history and order blood and urine tests to check for infection. In many cases, doctors refer people with suspected ME/CFS to other specialists to rule out other illnesses that could be causing symptoms.
For your doctor to diagnose ME/CFS, you must have these 3 symptoms:
- Severe fatigue lasting at least 6 months that does not improve with rest or sleep
- Difficulty sleeping
- Fatigue that gets worse after mental or physical exercise
Additionally, you must have at least 1 of the following symptoms:
- Orthostatic intolerance
Treatment Of Chronic Fatigue Syndrome
-
Cognitive-behavioral therapy
-
Graded exercise
-
Drugs for depression, sleep, or pain if indicated
In most cases, symptoms of chronic fatigue syndrome lessen over time. However, it often takes years for symptoms to subside, and not all symptoms disappear. People may recover more fully if they focus more on what function they can recover than on how much function they have lost.
Specific symptoms such as pain, depression, and poor sleep are treated. Cognitive behavioral therapy and gradual graded exercise, which have helped some people, may be worth trying.
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Key Points About Chronic Fatigue Syndrome
- Chronic fatigue syndrome is characterized by profound tiredness.
- Symptoms often worsen with physical or mental activity.
- In addition to severe fatigue, symptoms include light sensitivity, headache, muscle and joint pain, difficulty concentrating, mood swings, and depression.
- Treatments may include medicines, exercise, supplements, and counseling.
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How Can A Physical Therapist Help
Your physical therapist will work with you to develop a treatment plan for your specific condition. The goal will be to help ease your discomfort and improve your ability to perform daily activities.
Because people with CFS have fatigue, pain, and weakness, treatment may focus on improving short-term endurance and strength. Your physical therapist also may check for other conditions, like depression. They may refer you to other specialists to help manage your symptoms.
Physical therapy treatments may include:
Education. Your physical therapist may design a program to help you save energy while doing daily activities. They also may teach you sleep-health promotion techniques.
Movement and strengthening exercises. Moving and exercising can improve your short-term endurance and strength. Movement also can help reduce your pain. Your physical therapist will identify and teach you specific movements to help reduce your symptoms.
Manual therapy. Your physical therapist may use manual therapy to help ease your symptoms. This treatment is used to mobilize your skin, bones, and soft tissues, to help reduce pain and improve movement.
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Complementary And Alternative Medicine
CFS/ME patients tend to use more alternative medicine treatments than people without . Patients often leave orthodox medical care because they feel that their condition has been unjustifiably attributed to psychological causes: they are given the message that it is all in the mind. In a twin study, 91% of twins with CFS/ME and 71% without CFS/ME used at least one alternative treatment. A large proportion of the study participants stated that alternative treatments were helpful .
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How Is Chronic Fatigue Syndrome Diagnosed
CFS diagnosis depends on two criteria:
A specific treatment for CFS has yet to be proven effective. Vitamin supplements and medicines have some benefit. Many treatments just relieve the symptoms of CFS.
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Pacing Activity For People With Me/cfs
Pacing, or keeping within your available energy, is a self-management strategy to help people with ME/CFS make sure that they dont overdo activity or exercise. It reduces the likelihood of triggering PEM and can help reduce symptoms. Pacing is not a cure for ME/CFS and does not treat the underlying, physical cause of the disease.
The goal of pacing is for activity to be sustainable, so that the person can have some stability in their symptoms and what they can do each day. Pacing should be used in conjunction with rest.
The most challenging aspect of pacing is that PEM is very often delayed by as much as 24-48 hours, which can make it difficult to recognise when youve done too much. Using tools like an activity diary or heart rate monitor help you learn about your body and how much activity you can safely tolerate.
Suggestions on how to pace yourself include: