CFS/ME is a complex illness that impacts multiple body systems. There are currently no diagnostic tests or drugs available to diagnose/treat ME/CFS. Treatment approaches vary widely due to the complexity of these conditions and are focused primarily on symptom management. There are a few drugs that have been tried to treat ME/CFS, but research into their effectiveness is limited. Similarly, things like CBT, adaptive pacing, and nutritional supplements have been tried, but their effectiveness is still up for debate.
In this post, we will be discussing and summarizing the article, “Treatment and Management of Chronic Fatigue Syndrome/MYALGIC ENCEPHALOMYELITIS: All Roads Lead to Rome.”
(Disclaimer: I am not a medical professional and all information provided in this post is from the article which is available in the “references” section at the bottom of the page. This post is meant only to provide a synopsis of the information covered in the original article.)
Background
ME/CFS has recently been renamed Systemic Exertion Intolerance Disease (SEID) but, regardless of what you call it, ME/CFS is an extremely debilitating condition that has no known causes. ME/CFS is characterized by debilitating fatigue that does not improve with rest, cannot be explained by another underlying medical condition, and persists for more than 6 months. Furthermore, ME/CFS may present with symptoms such as post-exertional malaise, sleep dysfunction, cognitive issues, and muscle pain. ME/CFS is commonly discovered after infection from parasites, viruses, or bacteria. It is like waking up with the flu one day and never recovering.
Pharmacological Therapies
Although there is no cure for ME/CFS, numerous drugs are used to try and manage symptoms. There is a wide range of drugs that are prescribed to try and relieve symptoms, ranging from OTC NSAIDs to prescription immunomodulatory, antiviral, narcotic, anticonvulsant, and antidepressant drugs.
Mild Pain Relivers and NSAIDs
CFS/ME patients may use NSAIDs such as naproxen and ibuprofen for everyday aches and pains. Furthermore, other medications such as the anticonvulsants pregabalin and gabapentin may also be used for pain and sleep problems. Antidepressants can be used for depression/anxiety as well as for improved sleep. Finally, narcotic medications such as morphine, codeine, and tramadol may be used for a short time for extreme pain that cannot be treated with OTC drugs.
An additional drug is the COX-2 inhibitors. COX-2 inhibitors provide roughly the same effects as NSAIDs without the gastrointestinal side effects.
Antidepressants
CFS/ME patients often take antidepressant to treat the mood swings and depression that come with chronic illness. However, antidepressants almost always interact with other drugs which can cause serious complications. Additionally, tricyclic antidepressants may also be used to reduce pain and improve sleep quality.
SSRIs such as paroxetine, fluoxetine, and sertraline may be used for CFS/ME patients who experience mood disorders, anxiety, depression, chronic neuropathic pain, or fibromyalgia.
Antiviral and Immunomodulatory Therapy
Aside from rintatolimod, an immunomodulatory drug, recent research has not found any effective pharmaceutical treatments for ME/CFS. The drugs that have been researched include antiviral agents, hydrocortisone, SSRIs, and immunoglobulins. Rintatolimod is thought to work by increasing the production of NK-cells and influencing the 2-5A-synthetase pathway, which is important for defending against viral infections. Some CFS/ME patients have defects in their antiviral system such as up regulated RNase-L activity and low latent 2-5A-synthetase, both of which appear to be corrected by rintatolimod.
Fecal Microbiota Transplantation
Gastrointestinal issues are commonplace among CFS/ME patients, which may suggest a link between CFS/ME and the gut microbiome, but this has yet to be confirmed. A few studies have shown a good degree of success in treating CFS/ME patients through fecal microbiota transplantation (FMT). Fecal microbiota transplantation involves infusing liquid filtrate feces from a healthy person into the gut of a sick person to cure certain illnesses. Although this may sound like a disgusting treatment, it is being used to treat gut disorders with a good degree of success and will most likely continue to be studied in the upcoming years.
Complementary and Alternative Medicine
Overall, research has found nutritional supplements to be largely unhelpful in the treatment of CFS/ME, unless it is being used to treat a specific nutritional deficiency that has already been established. However, of the nutritional supplements available, the ones that have presented promising results in research are acetyl‐L‐carnitine, essential fatty acids, magnesium, vitamin B12, antioxidants, NADH (reduced form), and coenzyme Q10 plus NADH. These supplements have all been seen to improve CFS/ME in some cases, but further research is needed on most of them.
Non-pharmacological Approaches
Non-pharmacutecal therapies such as CBT, GET, and APT have been tried on CFS/ME patients. Cognitive behavioral therapy (CBT) was consistently shown to provide improvements in fatigue and quality of life, but did not seem to increase patients' ability to work. Graded exercise therapy (GET) is a form of activity that is started slowly and is gradually increased over time. GET seems to work best for CFS/ME patients when combined with CBT, however, some patient may also experience an intensifying of symptoms when trying to use GET, so it should be practiced with caution. Adaptive pacing therapy (APT) works to alter patients behavior while still allowing for symptom fluctuations and exercise recovery.
CBT, GET, and APT have all shown some success for CFS/ME patients, but studies are limited because the participants tended only to be the CFS/ME patients who were well enough to make it to research centers. As a result of this, most of these trials exclude those with CFS/ME who are housebound or bedbound. That being said, these approaches have still shown some promise, but should be used with caution.
Conclusion
There have been many different approaches studied for the treatment of CFS/ME. For the most part, all of the approaches have presented with a limited success rate, but there are still a number of treatments that look promising. Although there is currently no cure for CFS/ME, new research is coming out all the time and new treatments are starting to come with them.
References
Castro-Marrero, Jesus, et al. “Treatment and Management of Chronic Fatigue Syndrome/MYALGIC ENCEPHALOMYELITIS: All Roads Lead to Rome.” British Journal of Pharmacology, U.S. National Library of Medicine, 1 Mar. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301046/.
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