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Treatment: Medical
Medical treatment can be defined as
the use of therapies, such as
prescription medications or surgeries, that are specifically ordered and supervised by a physician. There
is no universal treatment for chronic fatigue and immune dysfunction syndrome (CFIDS), but medical treatments
can help specific symptoms.
Pain
Most 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 CFIDS (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
medications
that treat low blood volume, increase blood pressure or prevent blood from pooling in the legs may be
tried. Other potentially helpful medications are those that block the effects of 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 CFIDS 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.
Physical Malformations
Recent studies show
that in some
people,
CFIDS-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 CFIDS 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.
Mental Health
A common myth about CFIDS
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 CFIDS,
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 should always
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 CFIDS 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 CFIDS. 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.
Infections
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 CFIDS 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.
Medicines should always be taken as prescribed; because
one works,
it doesn't necessarily mean that two will work
better. The medication list found on this Web site provides
a list of medicines used to treat the various symptoms of CFIDS. Browse through our site for information
on many other CFIDS-related topics.
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