Treatment of chronic fatigue syndrome (systemic exertion intolerance disease)
- Stephen J Gluckman, MD
Stephen J Gluckman, MD
- Professor of Medicine
- University of Pennsylvania School of Medicine
Chronic fatigue syndrome (CFS), also known as systemic exertion intolerance disease (SEID), is a complicated and sometimes controversial disease characterized by unexplained persistent and relapsing fatigue. There is evidence of underlying abnormalities in the nervous system, the immune system, and metabolic function in affected patients. However, diagnosis can be difficult due to the lack of a test with adequate sensitivity and specificity. The long-term prognosis is unpredictable, and only about 15 percent of patients make a full recovery.
The treatment of CFS/SEID will be reviewed here. The clinical features and diagnosis of this disorder and the approach to the patient with fatigue are discussed separately. (See "Clinical features and diagnosis of chronic fatigue syndrome (systemic exertion intolerance disease)" and "Approach to the adult patient with fatigue".)
Many therapies have been tried in patients with chronic fatigue syndrome (CFS), also known as systemic exertion intolerance disease (SEID), but none is curative. Management is supportive and focuses on treating common comorbid conditions, which include sleep disorders, pain, depression and anxiety, memory and concentration difficulties, and dizziness and lightheadedness. Counseling therapies (eg, cognitive behavioral therapy [CBT]) and graded exercise therapy (GET) may be beneficial in some patients [1-3].
Many controversies remain about the optimal management of CFS/SEID. Clinicians and patients should be cautious about the use of unproven interventions that are potentially dangerous and often expensive.
Supportive approach — The best approach for the clinician is to establish a rapport with the patient to be able to provide support and reassurance.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- MANAGEMENT OVERVIEW
- Supportive approach
- Common symptoms/comorbidities
- Work modifications
- POTENTIALLY BENEFICIAL INTERVENTIONS
- Cognitive behavioral therapy
- Exercise therapy
- Limitations of studies
- USE OF MEDICATIONS AND DIET
- NEURALLY MEDIATED HYPOTENSION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS