Treating chronic fatigue syndrome

Treatments for chronic fatigue syndrome (CFS) aim tohelp relievethe symptoms.

The treatments used depend on how CFS affects you. Early diagnosis, taking medication to control certain symptoms, andchanging your lifestyle can all help.

CFSmay last a long time, buttreatment often helps improve the symptoms. Over time, many people get betterand regain fully functioning lives.

Treatmentprogramme

The National Institutefor Health and Care Excellence (NICE) advises that an individual programme of treatment should be offered to you. This will aim to:

• maintain and, if possible,increase your emotional and physical abilities
• manage the physical and emotional effects of your symptoms

You may be offered the treatments explained below, but remember thatwhat works for one person may not work for you.

The benefits and risks of each treatment should be explained to you, as some treatments could make your symptoms worse.

Both you and the healthcare professional treating you will decide on your treatment programme. You have the right to refuse or withdraw from any treatment recommended for you.

If your symptoms continue to get worse for several days after trying a certain treatment or if your symptoms are particularly severe, contact the healthcare professional treating you. It may be necessary to amend your treatment programme.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a type of therapy thatcan help you manageCFS by changing the way you think and behave. It's often used as a treatment for a range of health conditions.

CBTaims to help reduce the severity of your symptoms and the distress associated with CFS. Itworks by breaking down overwhelming problems into smaller parts, and by breaking the negative cycle of interconnected thoughts, feelings, physical sensations and actions.

Ideally, your CBT therapist will have experienceof dealing with CFS and treatment will be offered on a one-to-one basis. The treatment will be tailored to your needs and may include some of the following:

• helping you accept your diagnosis
• challenging feelings that could prevent your symptoms improving
• trying to increase your sense of control over your symptoms

The use of CBT doesn't mean CFS is considered to be a psychological condition. It's often used as a treatment for a variety of long-term conditions, such as cancer and rheumatoid arthritis .

Graded exercise therapy

Graded exercise therapy (GET) is a structured exercise programme that aims to gradually increase how long you can carry out a physical activity.

This usually involves exercise that raises your heart rate, such as swimming or walking. You'll have your own exercise programme adapted to your own physical capabilities.

GET should only be carried out by a trained specialist with experience of treating CFS and, if possible, should be offered on a one-to-one basis. After finding outwhat you can comfortably do already in the exercise (the baseline), you will gradually increase:

• the length of time you do the exercise
• the intensity of the exercise

As part of your exercise programme, you and your therapist will set goals, such as being able to walk to the shops or carry out some gardening. It may take weeks, months or even yearsfor you to achieve these goals, but it's very important not toexceed the exercise duration and intensity set for you.

Activity management

Activity management is another aspect of your treatment programme. It involves setting individual goals and gradually increasing your activity levels.

You may be asked to keep a diary of your current activity and rest periods to establish your baseline. Activities can then be gradually increased in a way you find manageable.

Medication

There's no medication availableto treat CFS specifically, but different medicines may be used to relieve some of the symptoms of the condition.

Over-the-counter painkillers can help ease anymuscle pain, joint pain and headaches you may have. Stronger painkillers can also be prescribed by your GP, although they should only be used on a short-term basis.

If you have chronic (long-term) pain, you may be referred to a pain management clinic. There are about 300 of these across the UK, mostly located in hospitals.

Antidepressants can be useful for people with CFS who are in pain or having trouble sleeping.Amitriptyline is a low-dose tricyclic antidepressant that may be prescribed.

It is not suitable for everyone for example, it may not be suitable if you have a history of heart problems. It can also cause side effects such as a dry mouth, blurred vision, dizziness and drowsiness.

If you experience severe nauseaas a result ofCFS, you may benefit from a type of medication called an antiemetic.

Lifestyle advice

As well as these treatments, you may find the lifestyle advice below helpful.

Pacing

Pacing may be a useful way of controlling CFS symptoms. It involves balancing periods of activity with periods of rest.

Itmeans not overdoing it or pushing yourself beyond your limits. If you do more than you are ready to,this could slow down your progress in the long term. Over time, you can gradually increase your periods of activity while making sure they're balanced with periods of rest.

Learning how to make the most of your energy helps increase the amount you can do. However, you may need to arrange your daily and weekly activities around when you can be active and when you need to rest.

If you pace your activities at a level that's right for you, rather than rushing to do as much as possible in a short space of time, you may be able to make steady progress.

However, there are some uncertainties about pacing. There's insufficient evidence on the benefits or harm of this treatment, although it's often recommended for CFS.

Other recommendations

The following recommendations may also help:

• avoid stressful situations
• avoid alcohol, caffeine, sugar and sweeteners
• avoid any food and drink you're sensitive to
• eat small regular meals to help reduce any nausea
• spend time relaxing
• try not to sleep or nap excessively, as this doesn't help and may make any sleeping problems worse

Relapses

A relapse is when your symptoms get worse for some time,leavingyou unable to function at the level you previously managed.

Relapses are a common part of CFS and can be caused by a number of factors, such as an infection or an unplanned activity. Sometimes there's no clear cause.

The healthcare professionals treating youcan help you manage your relapseby:

• including more breaks with your current levels of activities
• teaching you relaxation and breathing techniques
• encouraging you to be optimistic about your recovery

Over time and with treatment, many people with CFS begin to show improvement.

Complementary therapies and supplements

Although some people with CFS have reported improvements from complementary therapies , there's little evidence to suggest they're effective for the condition. This means their use isn't usually recommended for CFS.

There's also insufficient evidence to recommend taking dietary supplements, such as vitamin B12 and vitamin C for CFS.