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Treatment Overview: Chronic Fatigue Syndrome (CFS)

• Familiarize yourself with the 1994 International Case Definition.
  Exclude other possible diagnoses (e.g., anemia, hypothyroidism, lupus,
  Lyme disease, MS).
• Consider that CFS has a widely heterogeneous patient population. The varying subsets can be grouped, for example, by onset characteristics or symptom patterns, making treatment options even more challenging.
• Address symptoms and psychosocial issues comprehensively; treatment for CFS is symptom-based and supportive.
• Account for medication sensitivities. CFS patients are frequently hypersensitive to medicines, foods and vaccines. Try prescribing a fraction of the usual recommended dosage to start and increase slowly, as necessary, to tolerance and to achieve symptom relief.
• Stay alert for symptoms of sleep disturbances. Unrefreshing sleep is a nearly universal CFS symptom. Improving sleep can positively impact other symptoms. Consider sleep studies and/or referral to a sleep specialist for appropriate patients.
• Treat pain as needed. NSAIDS are the first step. As a last step, long-acting narcotics may be necessary for patients with unrelenting, severe pain. Referral to a chronic pain management program may be helpful as well.
• Provide a place for CFS patients to recline as many have difficulty staying upright for more than several minutes at a time. Treat orthostatic intolerance with fluid management and medications such as beta-blockers or alpha agonists.
• Remember that many CFS patients have cognitive problems such as difficulty concentrating and short-term memory deficits. Enhance verbal communication with written instructions and/or tape recorded instructions or consultations.
• Allow extra time for interaction when and however possible. Consider referral to a counselor or other behavioral health professional who is able to extend patient contact to discuss the impact of the illness on the patient, family, finances, etc.
• Utilize simplified psychological evaluation tools and functional capacity tools to screen for psychological or physical dysfunction. There are easy-to-administer instruments available that can be managed in the primary care setting. It is not unusual for CFS patients to become depressed or anxious as they try to cope with the complexities of a chronic illness; using these types of assessment tools to trend emotional health and physical status over time can help in detecting the onset of a problem, and deterioration or improvement in symptoms.
• Help prevent deconditioning in your CFS patients. Try working with patients to develop individualized, modest stretching and exercise plans, or consider referral to a physical or occupational therapy program.
• Encourage a well-balanced diet to prevent nutritional deficiencies or weight fluctuations.
• Be particularly conscious of your attitude. Many patients experience skepticism and disbelief from others about their illness. These attitudes can make them sensitive to verbal and non-verbal signs of disrespect and lack of acceptance of their reality in living with CFS. Treating patients with respect and validating their illness may be the single most important therapy you can provide.

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