Chronic fatigue syndrome medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Treatment
Many patients do not fully recover from CFS, even with treatment.[1] Some management strategies are suggested to reduce the consequences of having CFS. Medications, other medical treatments, complementary and alternative medicine are considered. A systematic review has shown that CFS patients are less susceptible to placebo effects than predicted, and have a low placebo response compared to patients with other diseases.[2] CFS is associated with chemical sensitivity,[3] [4] and some patients often respond to a fraction of a therapeutic dose that is normal for other conditions.[5][6]
A 2005 review in the journal Curr Med Chem. concluded, “it seems that major drug targets in stress-related disorders are immune cells in terms of inhibition of proinflammatory cytokines and modulation of Th (cytokine pattern) responses”. In CFS, in a series of recent therapeutic trials several immunomodulating agents have been used, such as staphypan Berna, lactic acid bacteria, kuibitang and intravenous immunoglobulin. In particular, according to recent evidences, antidepressants seem to exert beneficial effects in augmenting NK cell activity in depressed patients. [7]
Adjunctive therapy
Improvement may occur with medical care and additional therapies of pacing, cognitive behavioral therapy (CBT) and graded exercise therapy (GET). The latter two therapies have been found to be efficacious in small trials, but patient organisations surveys have reported adverse effects.[8] Interventions involving rehabilitation therapies have been shown to be at least partially effective in some people with CFS. [9][10][11][12]
Some therapies recommended by different sources include:
- Adaptive pacing[8]
- Cognitive behavior therapy[13]
- Envelope theory[14]
- Graded exercise therapy[15]
- Yoga[16]
- Physiotherapy[17]
References
- ↑ Rimes KA, Chalder T. (2005). "Treatments for chronic fatigue syndrome". Occupational Medicine. 55 (1): 32–39. doi:10.1093/occmed/kqi015. PMID 15699088.
- ↑ Cho HJ, Hotopf M, Wessely S (2005). "The placebo response in the treatment of chronic fatigue syndrome: a systematic review and meta-analysis". Psychosom Med. 67 (2): 301–13. doi:10.1097/01.psy.0000156969.76986.e0. PMID 15784798.
- ↑ Jason LA, Taylor RR, Kennedy CL (2000). "Chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities in a community-based sample of persons with chronic fatigue syndrome-like symptoms". Psychosom Med. 62 (5): 655–63. PMID 11020095.
- ↑ Clauw DJ (2001). "Potential mechanisms in chemical intolerance and related conditions". Ann. N. Y. Acad. Sci. 933: 235–53. PMID 12000024.
- ↑ Gruber AJ, Hudson JI, Pope HG (1996). "The management of treatment-resistant depression in disorders on the interface of psychiatry and medicine. Fibromyalgia, chronic fatigue syndrome, migraine, irritable bowel syndrome, atypical facial pain, and premenstrual dysphoric disorder". Psychiatr. Clin. North Am. 19 (2): 351–69. doi:10.1016/S0193-953X(05)70292-6. PMID 8827194.
- ↑ National Center for Infectious Diseases (2005-05-11). "Treatment of Patients with Chronic Fatigue Syndrome" (htm). Centers for Disease Control and Prevention. Retrieved 2008-04-07.
- ↑ Covelli V, Passeri ME, Leogrande D, Jirillo E, Amati L (2005). "Drug targets in stress-related disorders". Curr. Med. Chem. 12 (15): 1801–9. doi:10.2174/0929867054367202. PMID 16029148.
- ↑ 8.0 8.1 White PD, Sharpe MC, Chalder T, DeCesare JC, Walwyn R (2007). "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 Neurol. 7: 6. doi:10.1186/1471-2377-7-6. PMID 17397525.
- ↑ [Chambers D, Bagnall AM, Hempel S, Forbes C (2006). "Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review". Journal of the Royal Society of Medicine. 99 (10): 506–20. doi:10.1258/jrsm.99.10.506. PMID 17021301.
- ↑ Van Houdenhove B, Verheyen L, Pardaens K, Luyten P, Van Wambeke P (2007). "Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: should we treat low effort capacity or reduced effort tolerance?". Clin Rehabil. 21 (12): 1121–42. doi:10.1177/0269215507080769. PMID 18042608.
- ↑ van Weering M, Vollenbroek-Hutten MM, Kotte EM, Hermens HJ (2007). "Daily physical activities of patients with chronic pain or fatigue versus asymptomatic controls. A systematic review". Clin Rehabil. 21 (11): 1007–23. doi:10.1177/0269215507078331. PMID 17984153.
- ↑ Maquet D, Demoulin C, Croisier JL, Crielaard JM (2007). "Benefits of physical training in fibromyalgia and related syndromes". Ann Readapt Med Phys. 50 (6): 363–8, 356–62. doi:10.1016/j.annrmp.2007.03.021. PMID 17467103.
- ↑ Scheeres K, Wensing M, Mes C, Bleijenberg G (2007). "The impact of informational interventions about cognitive behavioral therapy for chronic fatigue syndrome on GPs referral behavior". Patient Educ Couns. 68 (1): 29–32. doi:10.1016/j.pec.2007.04.002. PMID 17521842.
- ↑ Jason LA, Melrose H, Lerman A; et al. (1999). "Managing chronic fatigue syndrome: overview and case study". AAOHN J. 47 (1): 17–21. PMID 10205371.
- ↑ Nijs J, Paul L, Wallman K (2008). "Chronic fatigue syndrome: An approach combining self-management with graded exercise to avoid exacerbations". J Rehabil Med. 40 (4): 241–7. doi:10.2340/16501977-0185. PMID 18382818.
- ↑ Bentler SE, Hartz AJ, Kuhn EM (2005). "Prospective observational study of treatments for unexplained chronic fatigue". J Clin Psychiatry. 66 (5): 625–32. PMID 15889950.
- ↑ Nijs J, Meeus M, De Meirleir K (2006). "Chronic musculoskeletal pain in chronic fatigue syndrome: recent developments and therapeutic implications". Man Ther. 11 (3): 187–91. doi:10.1016/j.math.2006.03.008. PMID 16781183.