Designing Your Chronic Fatigue Treatment Plan | Everyday Health

Chronic fatigue syndrome treatmentis a very individual thing, based on each patient’s symptoms and response to different therapies.

How you describe your symptoms ofchronic fatigue syndromewill often guide your treatment plan. “A lot of it has to do with how patients answer the questions,” explains Morris Papernik, MD, a doctor in private practice with ProHealth Physicians Group in Glastonbury, Conn., and a member of the U.S. Department of Health and Human Services Chronic Fatigue Syndrome Advisory Committee. “That’s what we tell residents and medical students all the time — it’s not a cookbook type of science here. We’re dealing with an illness that is somewhat nebulous. You need to practice the art of medicine.”

For example, how a patient describes her sleep and fatigue problems will help direct chronic fatigue treatment recommendations. “If a patient complains of fatigue and lack of energy, you say, ‘Tell me about your sleep.’ Maybe sleep is not the problem — it could be daytime energy,” says Dr. Papernik. Treatments for boosting daytime energy are different than those used toease sleep disturbances.

Chronic Fatigue Treatment Options

Among treatments that may be helpful for patients with chronic fatigue symptoms are these classes of drugs:

Antidepressants and benzodiazepines.虽然不是每个人都患有慢性足总tigue syndrome is depressed, someantidepressantscan help ease fatigue, pain, and disordered sleep. Cymbalta (duloxetineHCI) is one of the most commonly prescribed antidepressants, followed by Effexor (venlafaxine). ThebenzodiazepineKlonopin (clonazepam) may also be used to help people sleep at night.
Anticonvulsants.For reasons that are not clear, medications typically used for prevention of seizures can sometimes help people with CFS.Lyrica (pregabalin)may be prescribed, especially for patients who also havefibromyalgia pain.Lyricahas been shown to reduce pain and physical discomfort in these patients.
Thyroid medications.Thyroid治疗可以补充其他peo的治疗方法ple who are not responding as expected, especially ifthyroid hormonelevels are borderline. "Lots of times we will add thyroid pills to the mix if patients are not getting the response that we look for," says Papernik.
Stimulants.Provigil (modafinil) or Nuvigil (armodafinil) may be prescribed to increase daytime alertness. “Some people go so far as to use amphetamines,” says Papernik, although he does not recommend this approach over a long period.
Pain medication.For patients who experience severe headaches, joint pain, or other pain that is not managed with other treatments, pain medications may ease those symptoms.

The possibility of a link between a virus called XMRV and chronic fatigue syndrome may have patients seeking a type of treatment called antiretroviral therapy. XMRV is classified as a retrovirus, which means infection with it may allow other, previously dormant (inactive) viruses within the body to reactivate. Thehuman immunodeficiency virus (HIV)is the best-known retrovirus, and the antiretroviral drugs on the market are aimed attreatment of HIV, not XMRV.

Papernik warns against the retroviral treatment approach because there is no test that can reliably tell you if you have XMRV and because its role in CFS is not clear. Current antiretroviral medications have many strong side effects that make them inadvisable for treatment of unproven XMRV infection.

Alternative Treatments for Chronic Fatigue Syndrome

You may hear a lot about vitamin therapy and other kinds of herbal supplements that are said to ease chronic fatigue symptoms. However, says Papernik, the onlyalternative therapies for chronic fatigue syndromethat have been shown to work better than placebos are:

CoQ10(coenzyme Q10), 100 milligrams (mg) three times a day
NADH (nicotinamide adenine dinucleotide), 5 mg twice a day
SAM-E, 200 to 400 mg twice a day

Many CFS patients try acupuncture,valerian root,aloe vera, and magnesium, Papernik says. While there is no data to support these treatments, Papernik points out that they probably don’t cause any harm.

A Word of Caution About Chronic Fatigue Treatment

The lack of a standardized approach to chronic fatigue treatment means that patients may encounter advertisements from companies claiming to have a product to help with chronic fatigue symptoms, as well as practitioners who promise a quick cure. At the opposite end of the spectrum, CFS patients may encounter doctors who do not take their symptoms seriously. Papernik advises patients to be cautious when selecting a treatment approach. He warns patients to avoid doctors who:

Do not appear to be listening toyourdescription ofyourchronic fatigue symptoms — one size does not fit all in the CFS world
Tell you that your experience is all in your head and want to refer you to apsychiatrist
Are interested in selling you a line of vitamins offered in their office
Push intravenous vitamin,antibiotic, or antifungal treatments, which have not been shown to work better than placebos

Remember, finding the right doctor and communication are the keys to successfully treating chronic fatigue syndrome — and that means communicating with your doctor openly and clearly about symptoms, side effects, and any traditional or alternative medicine options you're using.