Current therapeutic strategies for myalgic encephalomyelitis/chronic fatigue syndrome: results of an online survey

Background: The treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) symptoms poses significant challenges. Purpose: To enumerate current clinical treatment strategies for ME/CFS. Methods: A survey was deployed via the Internet to eleven expert clinicians in ME/CFS. The experts rated medications for 18 symptoms and listed symptom groups that they considered as interrelated and representative of different ME/CFS phenotypes. Respondents rated drug efficacy on an ordinal scale (1 = very effective to 5 = not effective). Free text was also permitted to comment on treatment strategies and ME/CFS phenotypes. Results: Data were available for 11/20 respondents. Citalopram was reported to be more than moderately effective for depression/anxiety and similarly fentanyl for muscle aches and arthralgias. Low-dose stimulants and low-dose bupriopion were viewed as effective for fatigue by five respondents. Regarding ME/CFS phenotypes, respondents suggested that (a) sleep improvement can ameliorate post-exertional malaise, pain and headache, (b) treatment of orthostatic intolerance can improve fatigue, light headedness, mental fog, headache and pain, while (c) epigastric pain, reflux, and early satiety may suggest nutritional hypersensitivity. Conclusion: The views of ME/CFS experts regarding treatment strategies and drug efficacy can aid clinicians in the optimization of their practices, and perhaps can steer ME/CFS research in directions that hold promise.