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. Diagnosis can be difficult due to the lack of a diagnostic 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 etiology, clinical manifestations, and diagnosis of this disorder are discussed separately. (See "Clinical features and diagnosis of chronic fatigue syndrome (systemic exertion intolerance disease)".)
Many therapies have been tried in chronic fatigue syndrome (CFS), also known as systemic exertion intolerance disease (SEID), but only counseling therapies (eg, cognitive behavioral therapy [CBT]) and graded exercise therapy have been shown to produce meaningful benefit [1-5]. A systematic review of 35 randomized trials evaluating therapies for CFS/SEID concluded that counseling therapies and graded exercise therapy may have benefits for some patients with CFS/SEID . However, neither of these modalities is curative. There is no known specific medical therapy for CFS/SEID. Patients and their clinicians should be circumspect about trying potentially dangerous and often expensive regimens.
Cognitive behavioral therapy — CBT has been effective in patients with CFS/SEID 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 CFS/SEID 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 . 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 , 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 .
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