Medscape has published a review written by clinicians from around the US.

Let’s focus on 6 supportive care options for chronic fatigue and immune dysfunction syndrome, aka chronic fatigue syndrome (CFS) and myalgic encephalomyelitis.

1. Validate the illness experience.

  • Because CFS is an “invisible illness,” patients often don’t look sick.
  • Misconceptions about CFS being “all in your head” leave patients feeling misunderstood, isolated, and anxious.
  • Treat patients with respect and validate their illness.

2. Create a team/partnership approach.

  • The process of consulting many clinicians and spending thousands of dollars seeking a diagnosis can lead to distrust of the medical system.
  • Defuse past experiences with reassurances that CFS isn’t a form of depression or hypochondria.
  • Work with patients to create an individualized treatment program.
  • It’s going to take a long-term effort.

3. Professional counseling

  • Consult a mental health professional to help build coping skills.
  • Manage anxiety, depression, grief, anger, and guilt that accompany a chronic illness.
  • Combine medication and psychotherapy as needed.
  • Family dynamics can be dramatically altered when patients no longer perform traditional roles; therefore, encourage family members to participate.

4. Alternative therapies

  • The objective is to reduce anxiety, promote a sense of well-being, and reduce pain.
  • Consider deep breathing and muscle relaxation techniques; massage and healing touch; and movement therapies like stretching, physical therapy, yoga, qigong, and tai chi.
  • Hydrotherapy and acupuncture may help alleviate pain and improve energy in some patients.
    • Unfortunately, few studies are referenced in the article.

5. Cognitive behavioral therapy (CBT)

  • CBT helps patients cope with their illness, change behaviors that can contribute to symptom expression, and develop an activity plan to avoid postexertional malaise and deconditioning.

6. Support groups

  • It might be useful to meet with other people who have CFS.

The bottom line?
The authors tell us, “CFS can have a profound impact on daily life, requiring patients to make significant lifestyle changes and adapt to a series of new challenges… Changes in career, finances, lifestyle, self-esteem, and relationships are common.”

“The overall treatment plan should acknowledge these challenges and the patient’s emotional reaction to them. Educating patients about the link between stress and symptom exacerbation is key to establishing effective coping strategies and a positive approach to adapting to the illness.”

11/24/08 21:51

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.