Treatment for chronic fatigue syndrome and fibromyalgia, fibromyalgia and chronic fatigue syndrome rating scale - Plans Download

An evaluation of multidisciplinary intervention for chronic fatigue syndrome with long-term follow-up, and a comparison with untreated controls. Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses: elevated anti-early antigen antibodies. Serum levels of lymphokines and soluble cellular receptors in primary Epstein-Barr virus infection and in patients with chronic fatigue syndrome.
A preliminary placebo-controlled crossover trial of fludrocortisone for chronic fatigue syndrome. Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial.
Influence of exhaustive treadmill exercise on cognitive functioning in chronic fatigue syndrome. Effects of exercise on cognitive and motor function in chronic fatigue syndrome and depression.
Chronic fatigue syndrome: identification of distinct subgroups on the basis of allergy and psychologic variables.
Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. The effect of topical nasal corticosteroids in patients with chronic fatigue syndrome and rhinitis. Randomised double-blind, placebo-controlled study of fluoxetine in chronic fatigue syndrome. Because fatigue is a common symptom in many diseases, a wide differential diagnosis (Table 2)3 needs to be excluded. In particular, an early study7 reported that patients with CFS presented with symptoms similar to acute infectious mononucleosis and were found to have high titers of IgG antibodies to Epstein-Barr virus (EBV).
Numerous clinical trials of pharmacologic agents have been conducted but no definitive therapeutic benefit has been identified.Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) are common therapy for patients with CFS.
As the search for more effective treatment and, hopefully, a cure continues, future researchers may be drawn toward a holistic approach to CFS, specifically as an interaction among neural, endocrine, and immune systems. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests.
Tricyclic antidepressants have proven to be effective in reducing clinical depression and improving sleep patterns and are reportedly beneficial for patients with chronic fatigue.

Symptoms and treatment may differ from patient to patient depending on illness onset and genetic predisposition. For example, serologic and neurologic analyses for Lyme disease or multiple sclerosis need only be conducted if the patient presents with appropriate symptoms.TABLE 1Current CDC Criteria for Diagnosis of Chronic Fatigue SyndromeThe rightsholder did not grant rights to reproduce this item in electronic media.
Although clinical trials29 of tricyclic antidepressants have not produced definitive results, it is believed that along with their antidepressive effect they also promote stage 4, nonrapid eye movement sleep and stimulate the descending inhibitory pathways of pain control. Treatment of concomitant disorders such as migraine headache, irritable bowel syndrome, depression, panic disorder, and fibromyalgia may significantly improve the quality of life of the affected patient.6 Future technologic advances in neuroimaging, genotype profiling, immune assays, and pharmacologic therapy may bring greater consistency to scientific research and the possibility of improved therapy for patients with CFS. CFS is characterized by debilitating fatigue with associated myalgias, tender lymph nodes, arthralgias, chills, feverish feelings, and postex-ertional malaise. While anecdotal evidence and small noncontrolled studies support the use of the SSRIs fluoxetine (Prozac) and bupropion (Wellbutrin), placebo-controlled trials of these drugs have not significantly benefited patients with CFS.36,37 A recent investigation34 of nicotinamide-adenine dinucleotide (NADH) therapy reported promising results.
The authors of this report34 stipulated that a decreased adenosine triphosphate level, when alleviated by NADH therapy, improves muscle atrophy and neuroen-docrine abnormalities.Reports of subtle hypocortisolism in patients with CFS has spurred interest in treatment with mineralocorticoids and corticosteroids. Medical research continues to examine the many possible etiologic agents for CFS (infectious, immunologic, neurologic, and psychiatric), but the answer remains elusive.
Researchers suggested that this is a result of an inability to replenish activated natural killer cells.18 This hypothesis may explain how a triggering event, such as a viral infection, could produce a cascade of immune and neuroendocrine abnormalities. The varied nature of illness onset and infectious agents could produce different immune profiles among patients with CFS.
Fatigue was improved and disability was reduced without significant short-term adverse events.38Cognitive behavior therapy is a psychotherapeutic treatment postulating that patients with CFS may perceive their physical symptoms as insurmountable, thereby precluding any hope for recovery.
Similarities with fibromyalgia exist and concomitant illnesses include irritable bowel syndrome, depression, and headaches. Cognitive behavior therapy examines both the patient's cognition and behavior to identify unhealthy coping skills. Patients with chronic fatigue syndrome present with cognitive deficits in concentration, attention, and short-term memory.
Therapy should include exercise, diet, good sleep hygiene, antidepressants, and other medications, depending on the patient's presentation.
More specifically, persons with neurally mediated hypotension experience periods of light-headedness, syncope, and fatigue after periods of orthostatic stress (erect posture).
Other psychologic treatments such as support groups and a positive physician-patient relationship have proven to be beneficial in the long-term management of CFS.39The role of exercise in treating patients with CFS has recently been emphasized.
Chronic fatigue syndrome (CFS), also referred to as chronic fatigue immune deficiency syndrome, is a disabling illness characterized by persistent fatigue accompanied by rheumatologic, cognitive, and infectious-appearing symptoms.

Studies19,20 investigating this phenomenon as a cause of CFS have not produced consistent results.When treatments specific to neurally mediated hypotension were administered to patients with CFS, the results were inconclusive. Long-term physical inactivity can lead to physical deconditioning that further complicates the symptoms of CFS and has detrimental effects on mood, energy level, and both neural and immune functioning. Despite intense medical research, there is no known cause for CFS, but it appears to be a heterogeneous disorder which affects multiple systems, including hormonal, neurologic, and immunologic. Because there are no specific diagnostic tests or physical findings for CFS, diagnosis requires knowledge of possible symptoms and a method of exclusion. Alleviating allergy symptoms and stress may decrease the intensity and frequency of exacerbations, thereby improving the quality of life for persons with CFS. CFS is likely a spectrum of illnesses sharing a common pathogenesis with varying degrees of fatigue and associated symptoms. A later study25 using positron emission tomography analysis compared patients who had CFS and no history of depression with clinically depressed patients who had no history of CFS; the study found altered frontal cortical metabolism in both patients with CFS and patients with depression compared with healthy control subjects. This occurrence is reinforced by reports that patients with CFS are more prone to depression than healthy subjects and are often excessively emotional.26 Studies have shown that two thirds of patients with CFS have signs of major depressive illness and one half of all patients with CFS have experienced at least one episode of major depression. Although there is some overlap in symptoms presented by patients with CFS and those with depression, patients with CFS also show symptoms that are not typical of clinical depression, such as sore throat, lymphadenopathy, and postexertional malaise.
Patients with CFS lack feelings of anhedonia, guilt, and decreased motivation classically seen in patients with depression.26,27MUSCULARPatients with CFS often complain of myalgias and arthralgias, but exhibit no diagnostic signs of musculoskeletal disorder. Given the association between CFS and allergies, there is a strong possibility that allergies are essential to the pathology of CFS. Therefore, it is reasonable to hypothesize that allergens, similar to infectious agents, could serve as a triggering event for the many symptoms specific to CFS. Given the interactions among the hypothala-mic-pituitary-adrenal axis, neural and immune system, an allergen, similar to an infectious agent, can initiate a variety of symptoms along with severe fatigue, as is seen in patients with CFS. Exacerbations of allergic disease, such as rhinitis, could affect cytokine levels and natural killer cell function, thereby producing the abnormal immunologic and endocrine profiles seen in patients with CFS.

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