Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS) is a profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity.

See your doctor if you have extreme fatigue that has lasted at least 6 months, is not substantially relieved by rest, and causes a significant reduction in daily activities. Early diagnosis and management can substantially improve the probability of recovery.

CFS patients have been helped by lifestyle changes, including prevention of overexertion, reduced stress, dietary modifications, gentle stretching and nutritional supplementation.

The nutritional deficiencies worsen the symptoms of this condition. Hence, including a well-balanced diet with healthy foods is an important part in the treatment option for chronic fatigue.

The diet should contain healthy food items in order to restore energy and stimulate the immune system. Doing so helps in preventing dietary complications that are commonly observed among people with chronic fatigue syndrome.

Guidelines which help CFS –

Specialist treatments

There are a number of specialist treatments for CFS.

Cognitive behavioral therapy (CBT)

If you have mild or moderate CFS, you should be offered cognitive behavioral therapy (CBT).

CBT is a talking treatment that can help you manage CFS by changing the way you think and behave.

It can help you to:

• accept your diagnosis
• feel more in control of your symptoms
• challenge feelings that could prevent your symptoms improving
• gain a better understanding of how your behavior can affect the condition

Your CBT therapist will ideally have experience of dealing with CFS and treatment will be offered on a one-to-one basis.

Graded exercise therapy (GET)

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

It usually involves exercise that raises your heart rate, such as swimming or walking. Your exercise programme will be adapted to your physical capabilities.

After finding out what you can already do comfortably, the length of time you exercise and the intensity will gradually be increased.

As part of your exercise programme, you and your therapist will set goals, such as walking to the shops or doing some gardening. It may take weeks, months or even years for you to achieve these goals, but it's important not to try to do too much too soon.

Activity management

Activity management 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 specific medication for treating CFS, but medication can be used to relieve some of the symptoms.

Over-the-counter painkillers can help ease headaches, as well as muscle and joint pain. Your GP can prescribe stronger painkillers, although they should only be used on a short-term basis.

You may be referred to a pain management clinic if you have long-term pain.

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 to help ease muscle pain.

Diet and supplements

It's important you eat regularly and have a healthy, balanced diet. You should be offered practical advice about how to achieve this if, for example, your CFS symptoms are making it difficult for you to shop or prepare food.

If you feel sick (nauseous), eating starchy foods, eating little and often, and sipping drinks slowly may help. If this doesn't work, medication can be prescribed.

Diets that exclude certain food types aren't recommended for people with CFS. There's also insufficient evidence to recommend supplements, such as vitamin B12, vitamin C, magnesium, or co-enzyme Q10.

Sleep, rest and relaxation

You may have sleep problems that make your CFS symptoms worse. For example, you may:

• Have problems getting to sleep
• Have unrefreshing or restless sleep
• Need an excessive amount of sleep
• Sleep during the day and be awake at night

You should be given advice about how to establish a normal sleeping pattern. Having too much sleep doesn't usually improve the symptoms of CFS, and sleeping during the day can stop you sleeping at night.

You should change your sleep pattern gradually, and your doctor should review how it's going regularly. If your sleep doesn't improve after making changes, you may have an underlying sleep problem that will need to be addressed.

It's likely you'll need to rest during the day, and your doctor should advise you about the best way to do this. For example, they may suggest limiting each rest period to 30 minutes and teach you relaxation techniques, such as breathing exercises.

Other lifestyle changes to manage CFS

Other ways to manage CFS include:

• Equipment – some people may need a blue badge for parking, a wheelchair, a stair lift, or other adaptations for their home
• Changes in your place of work or study – when you're ready and well enough to return to work or studies, your doctor should be able to advise you on changes that could ease your return

There's limited or no evidence to recommend:

• Pacing – this is a technique that many people with CFS find helpful for managing their symptoms; the general aim is to balance rest and activity to avoid making your fatigue and other symptoms worse, but there hasn't been enough research into pacing to confirm whether it improves CFS or has any risks
• Resting completely – there's no evidence this helps

You shouldn't take up vigorous unsupervised exercise such as going to the gym or for a run as this may make your symptoms worse.

Setbacks or relapses

A setback or relapse is when your symptoms get worse for a period of time.

They're 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 doctors treating you can help you manage a setback or 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