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Familiarize yourself with the 1994
International Case Definition.
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Exclude other
possible diagnoses (e.g., anemia, hypothyroidism, lupus,
Lyme disease,
MS).
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Consider that CFS has a widely
heterogeneous patient population. The varying subsets can be grouped, for
example, by onset characteristics or symptom patterns, making treatment
options even more challenging.
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Address symptoms and psychosocial issues comprehensively; treatment
for CFS is symptom-based and supportive.
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Account for medication
sensitivities. CFS patients are frequently hypersensitive to medicines, foods
and vaccines. Try prescribing a fraction of the usual recommended dosage to
start and increase slowly, as necessary, to tolerance and to achieve symptom
relief.
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Stay alert for symptoms of sleep
disturbances. Unrefreshing sleep is a nearly universal CFS symptom. Improving
sleep can positively impact other symptoms. Consider sleep studies and/or
referral to a sleep specialist for appropriate patients.
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Treat pain as needed. NSAIDS are the
first step. As a last step, long-acting narcotics may be necessary for
patients with unrelenting, severe pain. Referral to a chronic pain management
program may be helpful as well.
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Provide a place for CFS patients to
recline as many have difficulty staying upright for more than several minutes
at a time. Treat orthostatic intolerance with fluid management and medications
such as beta blockers or alpha agonists.
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Remember that many CFS patients have
cognitive problems such as difficulty concentrating and short-term memory
deficits. Enhance verbal communication with written instructions and/or tape
recorded instructions or consultations.
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Allow extra time for interaction
when and however possible. Consider referral to a counselor or other
behavioral health professional who is able to extend patient contact to
discuss the impact of the illness on the patient, family, finances, etc.
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Utilize simplified psychological
evaluation tools and functional capacity tools to screen for psychological or
physical dysfunction. There are easy-to-administer instruments available that
can be managed in the primary care setting. It is not unusual for CFS patients
to become depressed or anxious as they try to cope with the complexities of a
chronic illness; using these types of assessment tools to trend emotional
health and physical status over time can help in detecting the onset of a
problem, and deterioration or improvement in symptoms.
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Help prevent deconditioning in your CFS patients. Try working
with patients to develop individualized, modest
stretching and exercise plans, or
consider referral to a physical or occupational therapy program.
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Encourage a well-balanced diet to prevent nutritional deficiencies or weight
fluctuations. Consider referral to a dietition.
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Be particularly conscious of your attitude. Many patients
experience skepticism and disbelief from others about their illness. These
attitudes can make them sensitive to verbal and non-verbal signs of disrespect
and lack of acceptance of their reality in living with CFS. Treating patients
with respect and validating their illness may be the singlemost important
therapy you can provide.
