CFS - Treating chronic fatigue syndrome

There is no cure for chronic fatigue syndrome (CFS), but treatments can help relieve the symptoms.

The treatments used will depend on how CFS affects you. Early diagnosis, medication to control certain symptoms and lifestyle measures can all help (see below).

CFS may last a long time, but treatment often helps improve the symptoms.

Treatment programme

The National Institute for Health and Care Excellence (NICE) advises that an individual programme of treatment should be offered to you with the aims of:

• maintaining and, if possible, extending your emotional and physical abilities
• managing the physical and emotional effects of your symptoms 

You may be offered the treatments explained below, but remember: what 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 who is treating you. It may be necessary to amend your treatment programme.

Cognitive behavioural therapy

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

CBT aims to help reduce the severity of your symptoms and the distress associated with CFS. It works 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 experience in 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 to accept your diagnosis
• challenging thoughts that could prevent your symptoms improving
• trying to increase your sense of control over your symptoms

The use of CBT does not mean CFS is considered to be a psychological condition. It is 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 will usually involve aerobic exercise (exercise that raises your heart rate) such as swimming or walking. You will have your own exercise programme adapted to your own physical capabilities.

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

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

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 years for you to achieve these goals, but it is very important that you do not exceed the exercise duration and intensity set for you.

Activity management

Activity management is another aspect of your treatment programme that 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 that you find manageable.

Medication

There is no medication available that can 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 any muscle 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. Amitriptyline 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 nausea due to CFS, you may benefit from a type of medication called an anti-emetic.

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.

Pacing means not overdoing it or pushing yourself beyond your limits. If you do, it could slow down your progress in the long term. Over time, you can gradually increase your periods of activity, while making sure they are balanced with periods of rest.

Learning how to make the most of your energy helps increase the amount that 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 is 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, it is important to note that there are some uncertainties about pacing. There is insufficient evidence on the benefits or harm of this treatment, although it is often recommended for CFS.

Other self-help techniques

The following recommendations may also help:

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

Relapses

A relapse is when your symptoms get worse for some time, leaving you 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 is no clear cause.

The healthcare professionals treating you can help you manage your relapse, by:

• 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.