Treatment of Chronic Fatigue Syndrome: Findings, Principles and Strategies

Chronic fatigue syndrome (CFS) is a debilitating condition characterized by serious medically unexplained mental and physical fatigue. The high prevalence and both direct and indirect health costs of CFS patients represent a huge problem for contemporary health care. Moreover, the prognosis of CFS, even when treated, is often poor. In this paper, we first critically review current evidence based treatments of CFS. Second, we discuss the growing insights into the etiopathogenesis of CFS, and the need to translate and integrate these insights into future treatments. In particular, we formulate a pragmatic and empirically testable treatment approach, tailored to the individual needs of patients, which aims at restoring the mental and physical equilibrium of CFS patients by trying to bring about sustained life style changes

Antidepressant-induced analgesia in chronic non-malignant pain: A meta-analysis of 39 placebo-controlled studies

For 39 controlled studies on the analgesic effect of antidepressants, a meta-analysis was conducted to get an estimation of the effect size, and to obtain a sight on the possible modes of action and the methodology used. The mean size of the analgesic effect was 0.64. It means that the average chronic pain patient who received an antidepressant treatment had less pain than 74% of the chronic pain patients who received a placebo. This quantification, however, is only as good as the studies on which it is based, and it could be differentiated for each of the pain syndromes and antidepressants examined. Real analgesic qualities of antidepressive agents seemed to offer the most plausible and economical explanation for the effect, but the predominant importance of serotonin reuptake blocking was not confirmed. Finally, the meta-analysis appeared to be fruitful for the generation of new hypotheses, for making some recommendations for future research, and for proposing some provisional guidelines for the clinical use of antidepressants in chronic non-malignant pain.status: publishe

Common and specific factors in the psychotherapeutic treatment of patients suffering from chronic fatigue and pain

Chronic fatigue conditions are very complex and heterogeneous disorders, both from an etiological and treatment perspective. Hence, it is not surprising that current evidencebased treatments have shown relatively limited treatment effects. In this article, we argue that extant treatment research has largely overlooked growing insights regarding the central role of attachment and stress regulation in these conditions and is largely based on the incorrect assumption that specific techniques are those mainly responsible for treatment outcome. In response, we propose an integrative, tailor-made, and staged treatment approach rooted in attachment and mentalization theory. This approach emphasizes the central importance of improvements in stress regulation as a result of an increased metacognitive ability to reflect on the self and others, which may lead to changes in lifestyle and increased resilience in the face of adversity. These changes may reflect a possible common mechanism of change across different treatments of these disorders. These issues are illustrated by a clinical vignette. © 2012 American Psychological Association.status: publishe

Does hypothalamicpituitaryadrenal axis hypofunction in chronic fatigue syndrome reflect a crash in the stress system?

The etiopathogenesis of chronic fatigue syndrome (CFS) remains poorly understood. Although neuroendocrine disturbances - and hypothalamic-pituitary-adrenal (HPA) axis hypofunction in particular - have been found in a large proportion of CFS patients, it is not clear whether these disturbances are cause or consequence of the illness. After a review of the available evidence we hypothesize that that HPA axis hypofunction in CFS, conceptualized within a system-biological perspective, primarily reflects a fundamental and persistent dysregulation of the neurobiological stress system. As a result, a disturbed balance between glucocorticoid and inflammatory signaling pathways may give rise to a pathological cytokine-induced sickness response that may be the final common pathway underlying central CFS symptoms, i.e. effort/stress intolerance and pain hypersensitivity. This comprehensive hypothesis on HPA axis hypofunction in CFS may stimulate diagnostic refinement of the illness, inform treatment approaches and suggest directions for future research, particularly focusing on the neuroendocrine-immune interface and possible links between CFS, early and recent life stress, and depression. (C) 2009 Elsevier Ltd. All rights reserved

Primary care physical therapy in people with fibromyalgia: opportunities and boundaries within a monodisciplinary setting

Despite the fact that people with fibromyalgia syndrome (FMS) frequently are seen by primary care physical therapists, guidelines for the management of FMS are based primarily on outcomes from multidisciplinary and tertiary care treatment studies. Few data addressing the treatment of patients with FMS in primary care currently are available. The evidence-based guidelines on the management of FMS are based, in part, on evidence from studies examining physical therapy treatment components alone (eg, aerobic exercise, education). Thus, the recommendations can be applied to primary care physical therapy. Primary care physical therapy for patients with FMS should include education, aerobic exercise, and strengthening exercise. For other treatment components such as passive treatments, activity management, and relaxation, less evidence currently is available to advocate their use in primary care physical therapy. Superior results are to be expected when various treatment components are combined

Vulnerability for Functional Somatic Disorders: A Contemporary Psychodynamic Approach.

Patients with functional somatic disorders (FSD) are markedly heterogeneous with regard to the factors contributing to their illness, their symptoms, and treatment response. In this article, we present a contemporary psychodynamic approach to the conceptualization and treatment of these patients based on attachment and mentalization theory. Extant research is reviewed that suggests a key role for attachment history and mentalization in determining stress and affect regulation, and immune and pain-regulating systems. We focus more specifically on the high interpersonal and metabolic costs associated with the excessive use of insecure secondary attachment strategies in response to stress, and the associated impairments in (embodied) mentalization in patients, both as a cause and consequence of FSD. Finally, a new brief psychodynamic intervention for patients with functional somatic complaints is discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved