General management and advice to patient and family

• Management of the fatigue state should focus on maximizing useful and sustainable functional activity, while avoiding levels and types of activity that cause setbacks. It should also focus on recognizing individual perpetuating factors.
• Approaches that have been shown to be successful include (ref 48) cautiously implemented graded exercise programmes,(ref 49,50) cognitive behavioural therapy, (ref 51) ‘Pacing’ and/or ‘living within limits’ is considered by some to be useful.
• Gather information from the patient’s previous experience to identify level of functioning, types of triggers for setbacks and factors leading to improvements. A diary might be useful.
• The patient may be able to build endurance by gradually increasing activity. Start with a manageable level and increase a little each week, if tolerable and sustainable without increased symptoms or disability.
• Emphasize pleasant or enjoyable activities to balance necessary tasks. Consider mixing the types of activity.
• Assess sleep patterns and normalize as much as possible. Encourage a regular sleep routine and, where appropriate, avoid daytime sleep. Consider medication (see Medication).
• Avoid excessive rest and/or sudden changes in activity.
• Recognize and treat psychological or physical co-morbidities.
• Explore what the patient thinks their symptoms mean. Offer appropriate explanations and reassurance. 
• Involving families could be important, and is essential when the patient is a child (see Unexplained medical symptoms (including chronic fatigue).
  

References

48 Whiting P, Bagnall A, Sowden A et al. Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. JAMA 2001, 286: 1360-1368. (AI) Forty-four studies were analysed. Interventions that have shown promising results include cognitive behavioural therapy and graded exercise therapy.

49 Fulcher K, White P. Randomised controlled trial of graded exercises in patients with chronic fatigue syndrome. Br Med J 1997, 314: 1647-1652. (AII) Fatigue, functional capacity and fitness were significantly better after exercise than after flexibility treatment in patients with chronic fatigue syndrome.

50 Powell P, Bentall R, Nye F, Edwards R. Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome. Br Med J 2001, 322: 387-390. (AII) Treatment of patients with Chronic fatigue syndrome incorporating evidence-based physiological explanations for symptoms was effective in encouraging self-managed graded exercise. This resulted in substantial improvement compared with standardized medical care.

51 Price JR, Couper J. Cognitive behaviour therapy for chronic fatigue syndrome in adults (Cochrane Review). In: The Cochrane Library, Issue 4, 1998. Oxford: Update Software. (AI) Three studies were analysed. Cognitive behaviour therapy appears to be an effective and acceptable treatment for adult outpatients with chronic fatigue syndrome.

Last edited: 26/1/2004

PREVIOUS 1 2 3 4 5 6 7 8 9 NEXT
(Page 6 of 9 in this chapter).