Journal Reading CFS

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Journal Reading

Chronic FatigueSyndrome: An Update on

Treatment in Primary CareHani Raoul Khouzam, MD, MPH

Advisor: dr. Parlin Susanto,

Sp.S

Presentant: Togi Stanislaus

Patrick (2010.061.137)


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General ManagementPrinciples

Treatment goals based on the stage andseverity of the disability

Referral to subspecialists

Individualized patient-centred treatmentplan with specific objectives

Patient education


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Non-pharmacologicalManagement

To help the patient achieve anappropriate balance between rest anddaily physical and mental activities

Pacing Approach

Most helpful

Exercise graded, supervised

To find a level of activity at which patientsfeel comfortable


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Relaxation Techniques

Can be used to manage pain, sleepproblems, and co-occuring stress or anxiety

Guided imagery and breathing exercise during periods of rest

Diet

Well-balanced diet

Eating regularly

Self-help Groups

Benefit instil ho e, offer an o ortunit


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Cognitive-behavioural Therapy (CBT)

Patients perform a cognitive assignmentthat entails gathering background details

and identifying automatic thoughts andcognitive errors

Challenge their perception of illness andgenerate alternative ways to view their

problems and to cope with their symptoms


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Mindfulness-based Cognitive-behaviouralTherapy (MCBT)

Based on mind-body interaction and on

practicing mindfulness meditation

How to focus on the present moment andact with purpose rather than letting

judgements about past events or fearsabout what may happen in the future affectcurrent feeling helps patients respondpositively


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Education and Employment

Occupational health services, disabilityservices, home education services

To initiate flexible adjusments to work orstudies to help patients resume theiremployment or education wheneverpossible


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Treatment of Co-occuringConditions

Depression

Mild moderate CBT, antidepressantmedication

Psychiatric consultation severe orchronic depression, suicidal intentions,social isolation, poor symptom control

TCA : amitriptyline, desipramine,nortriptyline

SSRIs : fluoxetine, paroxetine, sertraline

SNRIs : venlafaxine, duloxetine


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Anxiety

Benzodiazepines patient education

SSRIs and SNRIs more advisable

Sleep Disturbances

Sleep hygiene techniques regulatingtimes of going to bed and getting up,relaxing during the day, controlling sleepenvironment

Underlying sleep disorder low dose

antidepressant (amitriptyline, trazodone, ormirtazapine)


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Pain

Acetaminophen and NSAIDs

Phenytoin, gabapentin, divalproex sodiumneuropathic pain

Muscle relaxants (cyclobenzaprine),antispasmodics (baclofen) panful muscle

spasmsOpiates is not recommended in a primary

care setting

Transcutaneous electrical nerve stimulation


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Controversial and ExperimentalTherapies

CNS Stimulants

Methylphenidate reduce fatigue andimprove mental concentration in patients

with ADHD and CFSModafinil increase wakefullnes

D-Ribose

Significantly ameliorate symptoms of CFSwith particular benefit in participantsenergy level and overall sense of well being

Not recommended in primary care setting


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TERIMA KASIH

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Journal Reading CFS