PainMost pain relief therapy begins with over-the-counter medications such as aspirin, acetaminophen (Tylenol) or ibuprofen (Advil). If these do not bring relief, moderately severe pain may be treated with a mild narcotic. Long-acting narcotics are reserved for severe, unrelenting pain. It is generally wise to avoid narcotics because of their potentially addictive qualities, but there are cases in which they become necessary. Supportive treatments, such as meditation and biofeedback, may be quite helpful. Pain management counseling is another supplemental therapy that needs to be seriously considered.
Orthostatic Intolerance When healthy people stand, gravity causes about 750 cc (3 ¼ cups) of blood to fall to their legs and abdomen, which results in decreased blood flow to the brain. They do not experience adverse symptoms. However, persons with orthostatic intolerance (OI) do develop symptoms while standing or sitting and may become dizzy, lightheaded and/or weak.
If a person with CFS (PWC) has OI , their health care provider may suggest increasing water intake to at least 2 liters per day and increasing salt intake to 10-15 grams per day. This treatment is generally safe for most people, but if a person has heart or blood vessel disease, increased fluid and fluid retention could put an extra strain on the heart and blood vessels and cause serious problems. PWCs need to discuss this treatment with their primary care providers before attempting this themselves.
If symptoms do not improve with this treatment, prescription epinephrine, a naturally occurring substance in the body that acts as a mediator for body chemicals that affect smooth muscles, blood vessels and other body tissues.
Central Nervous System Studies suggest that CFS is associated with decreased levels of the neurotransmitters serotonin and dopamine, which may lead to disruptive sleep, a low pain threshold, irritability and depression. Low doses of selective serotonin re-uptake inhibitors (SSRIs), such as Zoloft or Paxil, or medications that affect the release of dopamine may provide relief.
Recent studies show that in some people, CFS-like symptoms may be caused by a narrowing of the area where the spinal cord and brain connect. Two defects of this area include: 1) Chiari malformation and 2) cervical stenosis. Both are potentially corrected with surgery. People with CFS report both successes and failures after surgery. Diagnostic tests, including specialized MRIs (magnetic resonance imaging) can be ordered for PWCs to determine if surgery is an option. Surgery facts should be discussed at length with a physician and a second opinion sought.
A common myth about CFS is that it is a form of depression, but numerous research studies have successfully revealed factual information that challenges this myth. While many PWCs do have periods of depression, it is usually secondary to CFS, as people learn to cope with the life changes that occur with a chronic illness. Antidepressants may be prescribed, but they are not a cure-all and must be used with caution. A supportive counselor can help PWCs deal with the family issues, anxiety, depression, grief, anger and guilt that frequently accompany chronic disorders.
Sleep Disruption Sleep disorders are reported by a great majority of PWCs. Over-the-counter sleep aids and antihistamines, such as Tylenol PM or Benadryl, can often be used to help alleviate sleep problems. Melatonin, a natural brain hormone, induces restful sleep in some people and can be purchased over the counter. The use of over-the-counter medications shouldalways be discussed with the PWC's primary care provider to prevent unwanted side effects.
Antidepressants and hypnotics are also used for relief of sleep difficulties. Many prescription sleep medications can be habit-forming, may increase depression or interfere with thought processes; therefore, they need to be used with care. In addition, many commonly used medications, including some antidepressants, can disrupt sleep.
Cognitive Dysfunction Many PWCs report that cognitive dysfunction is the most distressing CFS symptom. Impaired memory, difficulty finding words and/or using words and numbers, abstract reasoning difficulties and altered spatial perceptions are examples of cognitive-type impairment. Some PWCs experience symptom improvement when treated with the anticonvulsant, gabapentin (Neurontin). Scientists don't really know how this medication works but it appears to "even out" the nerve messages in the brain and helps the brain to respond to impulses at a steady rate.
Immune Dysfunction Multiple studies point to irregularities with the body's immune system as a possible cause of CFS. To treat the irregularities, medications called immune regulators are used. Gamma globulin (see second article under additional resources) and poly(I)-poly(C12U) (Ampligen) are two medications in this category. Gamma globulin, one of the first medications used to treat CFIDS, continues to be scrutinized for its effectiveness. PWCs who have received this treatment report variable symptom relief - it appears to help some and not others. Ampligen remains in clinical trials under the supervision of the U.S. Food and Drug Administration (FDA). Availability is limited to PWCs with access to a clinical site and the financial resources to cover the cost. Symptom improvement has been inconsistent with this therapy as well, and further research is underway.
Gastrointestinal Disorders Many PWCs experience problems with their digestive tract, particularly with irritable bowel syndrome. Nausea; diarrhea (often alternating with constipation); abdominal, pelvic or back discomfort; passage of mucus in stools; bloating and distention are common symptoms. Symptoms are worsened by stress. Drug therapy includes antispasmodics, antidiarrheal and anti-anxiety medications. Supportive therapies focus on reducing stress and adopting a high-fiber diet.
Antibiotics, antiviral, and antifungal medications are prescribed for specific infections. Infections could possibly be determined by laboratory tests, which require a body fluid sample such as blood or saliva. A word about medications: People with CFS often are unusually sensitive to medications and lower than usual dosages may be necessary. Primary care providers will need to prescribe low starting doses (often much lower than what is considered to be therapeutic) and increase dosages slowly.
All medications, including over-the-counter drugs, have potential side effects. The doctor and pharmacist need to be informed of every drug the PWC is taking - even a daily multivitamin or nutritional supplement. There is always the potential for an unpleasant interaction when drugs are mixed.