Drug Topics - January 28, 2008 - (Page 24) 24 DRUG TOPICS JANUARY 28, 2008 www.drugtopics.com CONTINUING EDUCATION Table 4 Chronic fatigue syndrome at a glance Definition Symptoms Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that doesn’t improve with bed rest and may worsen with physical or mental activity. People with CFS experience fatigue that lasts a long time. Symptoms may include headaches, sore throat, tender or painful areas in the neck or armpits, unexplained muscle soreness, pain that moves from joint to joint without swelling or redness, loss of memory or concentration, trouble sleeping and extreme tiredness after exercising that lasts more than 24 hours. These and other symptoms often won’t go away or keep coming back for six months or more. The exact cause of CFS is unknown. Some researchers suspect it may be caused by a virus, such as Epstein-Barr virus or human herpes virus-6 (HHV-6). However, no distinct viral cause has been identified. Recent studies have shown that CFS may be caused by inflammation of pathways in the nervous system, and that this inflammation may be some sort of immune response or process. CFS may occur when a viral illness is complicated by a problem with the body’s immune response. Other factors such as age, prior illness, stress, environment, or genetics may also play a role. CFS most commonly occurs in women ages 30 to 50. Living with CFS can be difficult. Like other debilitating chronic illnesses, CFS can have a profound impact on daily life, requiring patients to make significant lifestyle changes and adapt to a series of new limitations. CFS patients may find it therapeutic to meet with other people who have this illness, and often this can be accomplished by joining a local CFS support group. Currently, no specific medications are approved for CFS. Pharmacotherapy consists of appropriate symptomatic treatment. Symptomatic treatment can include, but may not be limited to, the use of analgesics, antidepressants, stimulants, sedatives, and nutritional supplements. Key medication management principles should be applied. These include: start with low dosing, increase gradually. Limit polypharmacy if possible. CFS patients will often require trials of multiple different medications, including those of the same class. Monitor side effects closely. Managing CFS can be as complex as the illness itself. There is no cure yet, no prescription drugs have been developed specifically for CFS, and symptoms vary considerably over time. These factors complicate the treatment picture and require the healthcare team to constantly monitor and frequently revise treatment strategies. It may take some time to find a combination of traditional and alternative therapies that works, but it’s important not to delay symptom management. For instance, untreated sleep problems can actually make other symptoms—like pain and memory problems—worse. The long-term outcome of remission or cure is not clear at this time. Some evidence suggests that symptoms improve within two years if their occurrence is associated with an acute onset such as after an infection; however, symptoms may last longer if the patient has a gradual onset of CFS. Empathize with patients and let them know you appreciate their illness. Discuss with patients their symptoms and expectations. Help patients with their anger and other psychological results of the disorder. Provide coping mechanisms including support groups and therapists as appropriate. Discuss medications the patient may be taking for symptoms. Urge patience. Provide assurance that the patient is not suffering alone. Chronic Viral Diseases Branch Division of Viral and Rickettsial Diseases National Center for Zoonotic and Vector-borne Enteric Diseases Centers for Disease Control & Prevention 1600 Clifton Road, NE, Mail Stop A-15 Atlanta, GA 30333 Causes Coping Drug treatment Prognosis Counseling points Other information & resources Source: Adapted from www.nlm.nih.gov/medlineplus/ency/article/001244.htm http://www.drugtopics.com http://www.nlm.nih.gov/medlineplus/ency/article/001244.htm
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