Therapy

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Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), remains unexplained. Studies on its causes have been multiplying in recent years, but still there is no clear evidence as to what exactly causes it. Thus, the treatment of CFS / ME relies on treating the presented symptoms. There are studies on the administration of drugs and hormones but have shown little or no results and in some cases significant side effects have been found. In addition, there have been studies on immunological and antiviral therapies. These studies, in many cases, are of low quality research and have small patient samples.

 

The National Institute for Health and Care Excellence of the United Kingdom [1] has concluded that the research done on administering vitamins, including injecting vitamin B12, vitamin C, magnesium and others, are not adequate and there is not need for them to be administered for treating symptoms in CFS / ME.

 

The National Institute for Health and Care Excellence emphasizes the importance of early symptom management, proper diagnosis, and working together with people with CFS / ME to manage the situation. According to the institute, advice on symptom management should not be delayed until a diagnosis is made. Advice should be adapted to the specific symptoms that a person with chronic fatigue presents and aim to minimize their impact on daily life activities.

 

The institute proposes two types of treatment for CFS / ME [1]:

  1. Graded Exercise Therapy (GET) and

  2. Cognitive Behavioural Therapy (CBT).

 

Graded Exercise Therapy (GET) is the use of regular exercise and physical activity designed to help people who feel fatigued, improve their physical condition and reduce difficulties in activities of daily living. Techniques based on treatment protocol [2], to address the limitations in CFS / ME, are used. GET starts with few activities, which increased gradually, without causing an increase in symptoms. The program includes a series of methodical steps to achieve the goals set jointly by the therapist and the patient [2,3,4]. The institute points out that GET should be provided ONLY by a qualified therapist with experience in CFS / ME [1]. For more information on the GET click here.

 

Cognitive Behavioural Therapy (CBT) is an evidence-based psychological therapy, which is used in many diseases, such as heart problems and diabetes. It is a therapy of co-operation aiming to reduce the level of symptoms associated with the condition. In CFS / ME this treatment usually consists of 12 - 16 sessions. CBT does not imply that the symptoms of a person with chronic fatigue are psychological or "made up in their mind" [1]. This treatment considers that CFS / ME is reversible and believes that cognitive responses, such as fear of engaging in activities or the avoidance of activity, contribute to the interaction of physiological processes and perpetuate fatigue. Thus, this treatment uses techniques and strategies to changes the behaviour of the individual towards the symptoms of chronic fatigue, thereby reducing or eliminating physical symptoms [2].

References

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  1. NICE, Clinical Guideline 53. Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy). Diagnosis and management of CFS/ME in adults and children, 2007.

  2. White et al. Protocol for the PACE trial: A randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome/myalgic encephalomyelitis or Encephalopathy. BMC Neurology 2007, 7:6

  3. Sharpe et al. Rehabilitative treatments for chronic fatigue syndrome: A long-term follow-up from the PACE trial. Lancet, 2015;2(12):1067-74. 

  4. White P, Goldsmith K, Johnson A, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 2011; 377: 823–36.