Pharmacological Treatment And Supplements
Pharmacological treatments have been shown to decrease rates of common CFS symptoms such as chronic fatigue, depression, and anxiety, while improving quality of life and physical performance variables . Proper supplementation of nutrients such as Vitamin B12, Folic Acid, Supradyn , NADH+ coenzyme Q, and D-ribose are safe treatment options . Replacing deficient lipid content and using antioxidant therapy have shown efficacy in patients who present with moderate to severe CFS symptoms .
The monoclonal antibody Rituximab, which is used for autoimmune diseases such as rheumatoid arthritis, showed no difference in comparison of effectiveness to controls when examining fatigue and functional status in CFS patients . Rintatolimod, a double stranded RNA compound, operates as an activating ligand for Toll-Like Receptor 3 in the innate immune system and provides relief of symptoms in 30 â 40% of CFS/ME patients . Urits et al. describe the importance of understanding what the cause of the fatigue, such as hypomagnesemia so that it may be treated appropriately with magnesium supplementation .
Getting The Right Diagnosis
Because CFS and narcolepsy are so alike, doctors may not be able to make a diagnosis simply by hearing about your symptoms. Some sleep tests can confirm if you have narcolepsy, but no single test can tell if you have CFS. Your doctor will have to do blood and urine tests to rule out other conditions first.
Complications Of Narcolepsy And Cfs
If left untreated, both narcolepsy and CFS can impact your daily life. You may stop doing activities you enjoy or find it hard to work. Over time, you could start to withdraw from others and become depressed.
Narcolepsy can also raise your risk of hurting yourself or others. For instance, you could fall asleep while driving a car.
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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
Who Is At Risk For Chronic Fatigue Syndrome
Because the cause of CFS is not known, its hard to know what might put someone at risk for getting the condition. However, certain factors are seen more often in people with CFS. These factors include:
- Gender. CFS happens up to 4 times more often in women than in men.
- Age. CFS commonly affects middle-aged people, but people of any age can get it.
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Can Chronic Fatigue Be Treated
Every patient experiences chronic fatigue differently, and it is often accompanied other medical problems. It is essential to understand the root cause of each persons fatigue through a thorough medical history and assessment. Once this is done, a comprehensive holistic treatment plan may combine multiple therapies to address problems such as pain or depression, coupled with lifestyle changes, stress reduction, and other adjunct therapies.
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Home Remedies And Lifestyle Changes
Making some lifestyle changes may help reduce your symptoms.
Limiting or eliminating your caffeine intake can help you sleep better and ease your insomnia. You should limit or avoid nicotine and alcohol too.
Try to avoid napping during the day if its hurting your ability to sleep at night.
Create a sleep routine. Go to bed at the same time every night and aim to wake up around the same time every day.
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Keep Track Of Your Symptoms And Their Onset
Tracking the frequency, timing, and severity of your symptoms might help your doctor better understand what youre experiencing. Tracking your activity level and symptoms can also help you draw connections and learn your limits so that you can reduce flare-ups.
When tracking your symptoms, remember to write down everything ailing you, not just fatigue. People with CFS/ME often also have issues with pain, cognition, such as memory and concentration, and sleep. You might also consider keeping a sleep diary, so your doctor can see how well youre sleeping and determine if sleep might play a role in your symptoms.
Drug And Alternative Therapies
Specific chronic fatigue syndrome symptoms such as pain, depression, and poor sleep are treated.
Many different drugs and alternative therapies have been tried to relieve the chronic fatigue itself. Although many treatments, such as antidepressants and corticosteroids, seem to make a few people feel better, none are clearly effective for all. It can be hard for people and doctors to tell which treatments work because symptoms are different in different people and because symptoms may come and go on their own.
Controlled clinical trials The Science of Medicine Doctors have been treating people for many thousands of years. The earliest written description of medical treatment is from ancient Egypt and is over 3,500 years old. Even before that, healers… read more , which compare the benefits of a drug to those of a placebo , are the best way to test therapies, and no drug therapy has been shown to be effective for the treatment of chronic fatigue syndrome in controlled trials. A number of treatments directed at possible causes, including use of interferons, intravenous injections of immune globulin, and antiviral drugs, have been mostly disappointing and potentially dangerous. Dietary supplements, such as evening primrose oil, fish oil supplements, and high-dose vitamins, are commonly used, but their benefits remain unproved. Other alternative treatments have also been ineffective. Treatments that have no proven benefits are best avoided because they can have side effects.
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The Wrong Way To Treat Chronic Fatigue Syndrome
Now you know the conventional medical therapies that are best suited to treat chronic fatigue syndrome. A lot of them dont have great research to support their use. So, be sure to have an in-depth discussion with your doctor. Discuss whether the potential side effects of the medication are worth it for the potential benefits.
There are other treatments that are often prescribed in conventional medical settings that are known to not be effective. And they may even have dangerous side effects. Below, I detail the conventional treatments of chronic fatigue that need to be avoided. These include:
- Graded exercise therapy
Graded exercise therapy
Graded exercise therapy or GET as its commonly referred to is an exercise plan specifically for those with chronic fatigue syndrome. Most patients with CFS report something known a post-exertional malaise this is a feeling of exhaustion or tiredness following exercise/activity. GET was developed in hopes to improve CFS patients resilience to exercise programs.
Graded exercise therapy remains a common conventional treatment for chronic fatigue syndrome. Even though patients typically remark that GET makes their symptoms worse. Thankfully, new research confirmed what CFS sufferers had been saying all along GET does not work. And it may actually make your fatigue worse.
Do not include GET in your chronic fatigue treatment. Instead, follow the recommendations I lay out for exercising with fatigue here, here, and here.
Sleeping pills
Home Remedies And Lifestyle
Making lifestyle changes may greatly impact how you feel, and the specific changes you need can depend on the severity of your illness and whether certain activities exacerbate your symptoms. While some people may see the tremendous benefit just from making changes to the way they eat, for example, others may find that more sweeping changessuch as a job changemay be necessary.
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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
- Trigger point therapy, called myofascial release
- 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.
Why Is This Important
The new research finds many CFS/ME patients feel unsupported by health professionals, which can make the illness all the more distressing. Patients want to be listened to, have their symptoms believed and be given realistic support that takes their life circumstances into account. They also want their beliefs about CFS/ME to be acknowledged, even if they are different to current medical theories. However, the study also found that views about the condition are highly polarised. This means it is challenging for professionals to provide the kind of care people want for CFS/ME.
The researchers suggest healthcare professionals should give personalised, empathetic care to their CFS/ME patients, and suggest treatments that minimise the impact on daily life. They say health professionals should provide a sense of safety. This way, patients may feel more able to work through complex issues, such as the mental health implications of CFS/ME, without feeling defensive or dismissed.
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Case Presentation: Case 1
A white British female, now aged 63 , developed viral meningitis with accompanying vomiting leading to severe dehydration in 1988 when aged 33. She had previously been well and working as a general practitioner. Viral meningitis was diagnosed by lumbar puncture and again 6 weeks later on repeat hospital admission. She remained extremely unwell, being bed bound and unable to self-care, with profound weakness and fatigue, general malaise, light and sound sensitivity, repeated dizziness causing collapse, persistent anxiety and widespread pain. Although she improved slowly over the next 5 years, she was only able to return to work on a limited basis, still suffering headaches, fatigue, postexertional malaise and frequent migraine attacks characterised by vomiting and visual disturbances.
Following gastroenteritis in 1999, she again became bed bound and unable to self-care. Improvement was slower than the initial illness, and after 5 years she was still dependent on carers and used a motorised wheelchair when outside. She developed multiple food intolerances, shown on blood tests and confirmed by repeated withdrawals and reintroductions of intolerant foods. She showed a more dramatic response to wheat, even small amounts, characterised by nausea, severe headache, rapid heart beat and collapse within 10min of consumption, followed by a week of reduced energy and absolute constipation.
Aberrant Energy Production Via Increased Glycolysis In The Warburg Effect
Cells from persons with ME/CFS show aberrant energy production, wherein more energy is produced within the cytoplasm via increased glycolysis and fermentation . Oxaloacetate has been shown to reverse this trend in human cancer cells, reducing both glycolysis and the formation of lactate . The Warburg Effect refers to a form of modified cellular metabolism, which tend to use specialized fermentation of pyruvate to lactate in the cytoplasm over the aerobic respiration pathway that burns pyruvate in the mitochondria that is used by most cells in the body under non-pathological conditions. Chronic Fatigue Syndrome patients have been shown to have activated this alternative energy pathway, increasing the amount of energy that is produced by glycolysis in the cytosol that continues after their pathological incident has passed .
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Compensation For And Correction Of Suppressed Endocrine Axes
Researchers have tried to correct suppressed endocrine axes in prolonged critically ill patients with the hope of reducing muscle wasting and mortality, and to aid recovery. The treatment trials can be grouped into two main approaches: treatments with non-tropic peripheral hormones, and the reactivation of the central endocrine glands. Whereas, the first approach compensates for suppressed endocrine axes by providing down-stream hormones into circulation, the second approach attempts to correct the endocrine axes themselves through interventions at the central level. We briefly summarize various treatment trials for each of these two broad approaches below. For each approach we also relate similar experimental treatment trials for ME/CFS and fibromyalgia in order to highlight the similarities in the quests to cure the two conditions, and to derive lessons for solving ME/CFS.
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What These Disorders Are
Narcolepsy is a chronic sleep disorder that upsets your bodyâs sleep-wake cycles. If you have it, youâll find it hard to stay awake for long periods of time, no matter what youâre doing. You could fall asleep while talking to someone else or while eating.
Itâs unclear what causes narcolepsy, but there are a few theories:
- Your genes could play a part.
- You could be low on a brain chemical that helps your body know when to sleep and when to stay awake.
- Your immune system could be attacking nerve cells in your brain by mistake.
CFS, which is now sometimes called myalgic encephalomyelitis, also makes you tired, but in a very different way. If you have CFS, you have extreme fatigue that lasts for 6 months or more and isnât a symptom of another health issue.
Like narcolepsy, experts donât know exactly what causes CFS. You may have it because of:
- A problem with your immune system
- Imbalanced hormones
- Physical or mental trauma
Anyone can have one or both of these conditions. Youâre more likely to have CFS if youâre a woman and slightly more likely to have narcolepsy if youâre a man.
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Diagnosis Of Chronic Fatigue Syndrome
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Laboratory tests to exclude other causes of symptoms
At least one of the following manifestations is also required:
-
Difficulty thinking
-
Feeling of light-headedness or dizziness when standing up that is relieved by lying down
The frequency and severity of the symptoms should be assessed by a doctor. If people do not have these symptoms at least half of the time with moderate, substantial, or severe intensity, doctors reconsider the diagnosis of chronic fatigue syndrome .
Criteria for diagnosis are important mainly because they help doctors communicate clearly with each other when they study a problem. However, when treating a specific individual, doctors focus more on that person’s symptoms rather than the criteria.
Causes Of Chronic Fatigue Syndrome
Despite considerable research, the cause of chronic fatigue syndrome remains unknown. Controversy exists as to whether there is a single cause or many causes and whether the cause is physical or mental, but either way the symptoms are very real to the person.
Some researchers believe the syndrome ultimately will prove to have several causes, including genetic predisposition and exposure to microbes, toxins, and other physical and emotional factors.
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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 summarizes the current drug therapeutic strategies for CFS/ME.
Living With Chronic Fatigue Syndrome
Although experts have not yet found a cure for CFS/ME, many people who have the illness are able to make lifestyle changes and find treatments that allow them to reduce or manage their symptoms. Improvement is possible by living within your limits and working with a doctor to find treatments that help you. There are also many CFS/ME support groups both online and in-person. Meeting with such a group might prove to be helpful.
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You may have sleep problems that make your ME/CFS symptoms worse. For example, you may:
- have problems getting to sleep
- have unrefreshing or restless sleep
- need an excessive amount of sleep
- sleep during the day and be awake at night
You should be given advice about how to establish a normal sleeping pattern. Having too much sleep does not usually improve the symptoms of ME/CFS, and sleeping during the day can stop you sleeping at night.
You should change your sleep pattern gradually, and your doctor should review how its going regularly. If your sleep does not improve after making changes, you may have an underlying sleep problem that will need to be addressed.
Its likely youll need to rest during the day, and your doctor should advise you about the best way to do this. For example, they may suggest limiting each rest period to 30 minutes and teach you relaxation techniques, such as breathing exercises.
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Metabolic Changes Seen In Me/cfs
Various metabolic mechanisms are turned on by the damage to the body, and these ongoing metabolic changes can cause lasting fatigue if they are not reprogramed back to the original normal metabolic state. Naviaux et al. suggests that these changes are characteristic of the Dauer state due to the cell danger response . One such metabolic change is the increase in glycolysis in the cytoplasm of the cell. This shift in metabolism was first described by Otto Warburg in the 1930s and has been named the Warburg Effect. Warburg described the metabolic energy shift in relation to cancer cells, and indeed, almost all cancers exhibit this change in energy metabolism. Otto Warburg thought that once the cell changed to this different energy production method, it could not change back into a normal cell. This energy pathway change can lead to pathological fatigue .
The Warburg Effect is not only present in cancer cells but is seen in adaptive immune cells of myeloid and lymphoid lineage, characterized by a shift to aerobic glycolysis . The Warburg Effect is present in the replication of viruses such as MERS-CoV and SARS-CoV-2 . Clinical work in ME/CFS patients shows this change to Warburg Effect metabolism, thus generating most of the energy currency, ATP, from non-mitochondrial sources .
Table 1 Metabolic Changes That May Affect Fatigue in ME/CFS Patients
Rationale of this study
Aim of this study
Experimental hypothesis of this study
