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Treatment of systemic exertion intolerance disease (chronic fatigue syndrome)

Stephen J Gluckman, MD
Section Editor
Mark D Aronson, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Systemic exertion intolerance disease (SEID), also known as chronic fatigue syndrome (CFS), is a complicated and sometimes controversial disease characterized by unexplained, persistent, and relapsing fatigue. Diagnosis can be difficult due the lack of objective clinical or laboratory findings associated with this disorder. The long-term prognosis is favorable in many cases, although treatment options are limited.

The treatment of SEID/CFS will be reviewed here. The etiology, clinical manifestations, and diagnosis of this disorder are discussed separately. (See "Clinical features and diagnosis of systemic exertion intolerance disease (chronic fatigue syndrome)".)


Many therapies have been tried in systemic exertion intolerance disease (SEID), also known as chronic fatigue syndrome (CFS), but only counseling therapies (eg, cognitive behavioral therapy) and graded exercise therapy have been shown to produce meaningful benefit [1-5]. A systematic review of 35 randomized trials evaluating therapies for SEID/CFS concluded that counseling therapies and graded exercise therapy may have benefits for some patients with SEID/CFS [5]. However, neither of these modalities is curative. There is no known specific medical therapy for SEID/CFS. Patients and their clinicians should be circumspect about trying potentially dangerous and often expensive regimens.

Cognitive behavioral therapy — Cognitive behavioral therapy (CBT) has been effective in patients with SEID/CFS and may be useful in those with idiopathic chronic fatigue [6-9]. This approach typically involves a series of one-hour sessions designed to alter beliefs and behaviors that might delay recovery. In a trial, 641 patients with SEID/CFS were randomly assigned to receive CBT, graded exercise therapy, or adaptive pacing therapy, which involves helping the patient to plan and pace activities to reduce fatigue; all patients also received specialty medical care [9]. Patients received 14 sessions of therapy during the first 23 weeks, and an additional session was offered at 36 weeks. When assessed at 52 weeks, CBT in combination with specialist medical care was associated with less fatigue and better physical function compared with specialist medical care alone. Graded exercise therapy led to similar benefits, but adaptive pacing therapy did not.

Similar findings were observed in a randomized trial that compared CBT with relaxation training in 60 patients [7], and the benefit persisted at five years following the intervention as assessed by an interviewer who did not know to which original group the patient had been assigned [8].


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Literature review current through: Sep 2016. | This topic last updated: Apr 27, 2016.
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