How to treat Chronic Fatigue Syndrome

fatigue syndrome

When you think about how to treat chronic fatigue syndrome (CFS) and how not to treat it, the obvious answer may not be the correct one.  Unfortunately, you cannot treat this type of fatigue with rest; in fact, that is the very definition of this condition: a debilitating and complex disorder characterized by intense fatigue that is not improved by bed rest.  On the other hand, the complications of living with CFS (including depression, social isolation, productivity loss, low stamina, memory and concentration problems, &c) can be decreased and prevented by making adjustments in four different areas:

1.       Treating the most troublesome symptoms first.

2.       Monitoring the use of medications and supplements.

3.       Managing activities and exercise.

4.       Enhancing health and quality of life.

Treating the most troublesome symptoms first

Chronic fatigue syndrome has many symptoms; some are a direct result of the condition while others are neither part of CFS case definition nor contribute to the diagnosis, but are nevertheless experienced many some patients.

Chronic fatigue syndrome symptoms



·         Feeling unwell or exhausted for more than 24 hours after physical or mental exertion.

·         Sleeping problems including unrefreshing sleep, Hypersomnia, frequent awakening, restless legs, and nocturnal myoclonus.

·         Memory problems.

·         Muscle and joint pain.

·         Sore throat.

·         Headaches of new type, pattern, or severity.

·         Enlarged and tender lymph nodes in the neck or armpits.

·         Abdominal pain.

·         Alcohol intolerance.

·         Bloating.

·         Chest pain.

·         Chronic cough.

·         Diarrhea.

·         Dizziness.

·         Dry eyes or mouth.

·         Earache.

·         Abnormal heartbeat.

·         Jaw pain.

·         Morning stiffness.

·         Nausea.

·         Chills and night sweats.

·         Shortness of breath.

·         Weight loss.


By focusing on the most disruptive symptoms first, a patient may expect a domino effect in which the rest of the symptoms will subside as well.

·         Fatigue and sleep problems. This aspect of CFS can be improved upon by practicing sound sleeping habits, such as the following:

-        Establishing a regular bedtime routine.

-        Avoiding day-time napping.

-        Implementing an extended wind-down period.

-        Using the bed for sleeping and sex exclusively.

-        Going to sleep and waking up at the same time every day.

-        Controlling noise, light and temperature.

-        Avoiding caffeine, tobacco, and alcohol.

-        Trying light exercise and stretching at least four hours before going to bed.


·         Pain. Chronic fatigue syndrome-related pain is usually managed with pain-relieving medication, for example aspirin, ibuprofen, or acetaminophen. Further CFS pain therapies may include stretching and movement therapies, gentle massage, heat, toning exercises, hydrotherapy, relaxation techniques, acupuncture, and electrotherapy

·         Memory and concentration problems. Relaxation and meditation techniques can help address cognitive issues, as can organizers, schedulers, written resource manuals, puzzles, word games, and card games.

·         Depression and anxiety. Approximately 50% of all CFS patients experience depression at some point during their illness, often as a result of having to adjust to the chronic and debilitating nature of this condition. Antidepressant medication, deep breathing and muscle relaxation techniques, massage and healing touch, and movement therapies like stretching, yoga and tai chi are usually prescribed to treat depression. It’s important to note that depression is a consequence of CFS and not the other way around; thus, addressing depression will not cure CFS.

·         Dizziness and lightheadedness. Also known as orthostatic instability, CFS patients may experience dizziness and lightheadedness when they stand upright. Treatment for orthostatic problems, which should only be prescribed after a proper diagnosis, includes volume expansion for patients who do not have heart or blood vessel disease.

Monitoring use of medication and supplements

Although there are several medications -both OTC and prescription- that can help manage CFS and its symptoms, they should be carefully prescribed and administered. For instance, mild stimulants may be help some patients, but stronger stimulants can lead to the so called ‘push-crash cycle’ of doing too much, crashing, resting, feeling better, and doing too much again. Healthcare providers should prescribe lower than standard doses of sedating medications and progressively increase the dosage if needed and tolerated. Moreover, multipurpose drugs such as tricyclic antidepressants -which can improve mood and sleep and relieve pain- should be used whenever possible in order to achieve better results with fewer medicines.

Vitamins and herbal supplements present an entirely different conundrum. Though they are largely unproven and unregulated, some patients report obtaining positive results from the use of these products, if only due to the placebo effect. Doctors and patients should weigh the risks of taking supplements against the benefits, and understand that they are no substitute for a nutritious, healthy diet.

Managing activities and exercise

CFS patients are at their worst in the hours, days and weeks that follow physical and mental effort. However, avoiding activity altogether will not only not improve the condition but can actually worsen the symptoms. For some patients, the mere act of going about their days will be enough exercise; for others, a few minutes of daily exercise will be all they can handle. Either way, learning how to pace themselves is the key to progress from what must be a very slow start.

Light, low impact. The majority of CFS patients can start with simple stretching and strengthening exercise using only body weight for resistance. At the beginning, a minute of exercise must be followed by three minutes of rest; later on sessions -divided into two or more per day- can be increased by one to five minutes a week as tolerance builds.

Strength and conditioning. Resistance and flexibility training may increase stamina and function, improve strength and flexibility, reduce pain, and enhance range of motion. Sets of two to four repetitions of hand stretches, sitting and standing, wall push-ups, and picking up and grasping objects are a sensible starting point. Once the patient has achieved a maximum of eight repetitions, they can move on to resistance band exercises for additional strength and flexibility.

Graded therapy exercise. Also known as GTE, this is a program that involves active stretching followed by range-of-motion contractions and extensions. A patient who has been completely inactive can start with five minutes a day. The goal of GTE is to complete a pre-determined time or number of repetitions -which will vary for each individual- before the patient tires out.

Enhancing health and quality of life

·         Cognitive behavioral therapy. This is prescribed in combination with other treatments to help patients regulate activity levels, stress and symptoms, and pace themselves so that they avoid the aforementioned ‘push-crash cycle.’

·         Support groups. Sharing, learning and talking about CFS can help patients cope better with this condition. Support groups are not for everybody, especially if the group is a front for selling products; though support groups may collect a modest voluntary donation to cover basic expenses, they should not profit from this serious condition. Look for support groups that have:

-        New and old patients that you feel comfortable around.

-        Empathizing leaders who are able to include all members in the discussion.

-        Signs that the needs of the members are met.

·         Professional counseling. A trained counselor can help patients and their families develop skills to cope with the grief, anger, and guilt that often come with chronic conditions, as well as enable the patient to seek encompassing care.