MANAGEMENT OF CHRONIC FATIGUE SYNDROME

Posted by Alex

Nonpharmacologic Management

Management of the patient with CFS requires more than pharmacotherapy. First, the clinician must make a personal judgment as to whether patients are accurately relating their symptoms -both those that they admit to and those that they deny. CFS is an illness defined only by symptoms. Thus, an occasional patient seeking secondary gain may fabricate a “perfect story” for CFS. Somewhat more commonly, patients who have been told that they are suffering from major depression and who find that diagnosis to be stigmatizing read about CFS in the media and come to believe that it explains their fatigue. So, the first task of the clinician is to make an admittedly arbitrary judgment as to the veracity of the symptoms reported. In my experience, with CFS and other illnesses, it is generally wisest to believe what the patient tells you.

It is therapeutic for the clinician to listen to the patient, take seriously the patient’s recounting of the illness, and explain honestly what is known and not known about the illness. The growing number of studies finding objective abnormalities in patients with CFS have convinced me that there is an underlying biologically based illness: there is “something wrong,” even if the pathogenesis is still unknown. It is antitherapeutic for the clinician to dismiss any patient’s symptoms out of hand, even when the clinician is convinced that the patient is suffering from a primary psychiatric disorder with somatizing features. This may be particularly true with CFS, which is a “delegitimizing” illness. This delegitimization probably augments a patient’s perception of symptoms and diminishes his or her sense of self-worth. It is an enormously frustrating thing, for both patient and clinician, when there is no definitive explanation for symptoms. The busy clinician can easily become impatient when dealing with any presenting complaint that does not have an obvious diagnosis. However, especially when a definitive therapeutic technology is not at hand, there is no substitute for patient and sympathetic listening and explanation. buy Ribavirin

In Table 2 are listed some nonpharmacologic treatments of CFS. Perhaps the most important nonpharmacologic treatment is to encourage patients to avoid unusual physical or emotional stress and to pace themselves; each day should have a regular routine. Patients should be encouraged to be as active and involved as they feel is possible, and the clinician may need to spend time explaining to employers why a scaled down, part-time work schedule is necessary. Modest regular exercise, to avoid deconditioning, is important. buy penisol

TABLE 2 – Steps in Managing the Patient with Chronic Fatigue Syndrome

Establish the diagnosis

Symptomatic treatment

Medications for depression, anxiety, pain, sleep, allergies

Avoid exotic untested remedies

Cognitive-behavioral therapy

Provide reassurance and emotional support

Acceptance of symptoms

Avoid confrontational approach

Referral to support groups and counseling

Lifestyle management

Apply stress reduction

Restructure activities

Make realistic goals

Prevent further disability

Graded exercise program

Physical therapy

Regular follow-up

Continue to rule out other medical problems