Symptoms & Treatment Principles

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By Bruce Campbell

(Note: From the series Treating ME/CFS and Fibromyalgia.)

Even though there is, so far, no cure for either ME/CFS or fibromyalgia, there are many ways to alleviate the symptoms of the two conditions. While treatments don't heal either either condition, they can reduce the effects of symptoms and help those destined for recovery to move forward.

Other articles in this series will give you the major treatment options for the four most prominent symptoms of ME/CFS and fibromyalgia: fatigue, pain, poor sleep and cognitive problems. This article offers a list of ME/CFS and FM symptoms and outlines an overall approach to symptom management.

People with either condition usually experience several or even many symptoms. Other common symptoms beyond fatigue, pain, poor sleep and cognitive problems include:

Abdominal pain (bloating, diarrhea/constipation)
Alcohol intolerance
Allergies & rashes
Anxiety
Chills or night sweats
Depression
Dizziness
Fever
Headaches
Jaw pain
Loss of libido
Lymph node tenderness
Nausea
Numbness or tingling in hands, arms, legs, feet or face
Ringing in the ears
Sensitivity to light, sound, smell or weather
Sore throat
Weight gain or loss

It is also important to mention that people with either ME/CFS or FM often have additional medical problems, so some of your symptoms may be due to other conditions, such as those mentioned in the article Overlapping and Related Conditions.

Treatment Principles

The approach to treatment we recommend is based on five principles.

1) Focus on Improving Quality of Life

Because so far there is no cure for either ME/CFS or fibromyalgia, the goal of treatment is not healing but rather controlling symptoms and improving quality of life. Medical treatments usually focus on addressing the most bothersome symptoms, such as poor sleep and pain.

Self-help strategies like pacing, exercise and stress reduction can also help you feel better and more in control. While treatments don't heal either condition, they can reduce pain and discomfort, bring greater stability and lessen suffering.

ME/CFS and FM affect many parts of your life, so managing them involves much more than just treating symptoms. The two conditions affect a people's ability to work, their relationships, their moods, and their hopes and dreams for the future. Managing them includes addressing stress and emotions, getting support and recasting relationships, and coming to terms with loss.

2) Use Multiple Strategies

Because people with ME/CFS and fibromyalgia have more than one symptom and because each symptom may have more than one cause, your treatment plan is likely to embrace many approaches. These often include both medications and self-management strategies.

For example, treating pain often involves both the use of medications and lifestyle strategies such as exercise; pacing; relaxation; the use of heat, cold and massage; setting limits and saying "no"; treating depression; and improving sleep.

Cognitive problems ("brain fog") are typically addressed with a variety of techniques, such as the use of lists, pacing, doing one thing as a time, keeping an orderly house, doing mental tasks when sharpest, managing stress, and reassuring self-talk.

The symptoms of ME/CFS and FM have several causes in common: overexertion, deconditioning, stress and emotions. Treating these causes with approaches such as pacing, exercise, relaxation and managing emotions has a multiplied effect, since each strategy affects multiple symptoms.

3) Experiment

Finding the most helpful combination of treatments often requires experimentation. There is no standard medical treatment for either illness, that is, no medication that is predictable effective. For this reason, symptom control is usually achieved by trial and error.

If you want to use medications to treat ME/CFS or FM, a sensible approach is to find a sympathetic physician willing to work with you to find the drugs that help in your individual situation.

Experimentation is also useful to find lifestyle adjustments that are effective. For example, you may have to try different exercise programs to find one that helps you without intensifying your symptoms.

We call this process of trying different approaches to find what works being your own ME/CFS or FM scientist. Through practice, you develop skills such as self-observation, researching treatment options, achieving short-term goals and problem solving.

4) Adjust Your Lifestyle

The things you do and the way you live have a big effect on your symptoms, reducing them if you honor your body's needs or intensifying them if you don't. Your success in reducing symptoms and regaining control of your life will probably depend more upon your efforts and willingness to adapt than on anything a doctor does for you.

In the words of ME/CFS and FM physician Dr. Charles Lapp, "There is no drug, no potion, no supplement, herb or diet that even competes with lifestyle change for the treatment of CFS or FM."

Lifestyle change strategies for controlling symptoms include exercise; relaxation and other stress reduction techniques; the use of pacing techniques like reducing overall activity level, having short activity periods, taking regular rests, and keeping records; addressing depression, loss and other emotions triggered by illness; support from family, friends and other patients; changes in diet; avoiding people and situations that trigger symptoms; and incorporating pleasurable activities into one's life.

5) Treat Other Medical Problems

As mentioned above, many people with ME/CFS and/or fibromyalgia experience additional medical problems, so consider the possibility that some of the symptoms you experience may be due to medical conditions other than ME/CFS or FM. Having multiple medical conditions complicates life and increases suffering, but by treating other conditions, you are likely to moderate your ME/CFS and fibromyalgia symptoms.

Other illnesses often found in people with ME/CFS include the following (listed alphabetically): allergies, candida (yeast infection), celiac disease, chemical sensitivity, depression, irritable bowel syndrome (IBS), neurally mediated hypotension (NMH), and sleep disorders such as apnea and restless legs syndrome.

Conditions occurring together with FM include depression, gastroesophageal reflux disease (GERD), irritable bladder syndrome (interstitial cystitis), IBS, Lyme disease, migraine headaches, myofascial pain syndrome, and sleep disorders such as apnea and restless legs syndrome.

Besides the conditions just described, people with Chronic Fatigue Syndrome and fibromyalgia also experience other medical problems, particularly those associated with growing older. Among people who take our self-help course, the following conditions are common in addition to those already mentioned: arthritis, asthma, back and spinal problems, diabetes, high blood pressure, and thyroid problems.