by Colin Payton

Created on: March 06, 2010

One of the commonest and most damaging misconceptions about chronic fatigue syndrome (CFS) is that it is necessarily a long term or even permanent condition. A damaging belief for the general public because they think that sufferers don’t ever get better and this colours their perception of sufferers. For example, employers are much less likely to take someone on if they know they’ve suffered from CFS because they think they can’t have fully recovered and will remain disabled. A damaging belief for sufferers because this inhibits their recovery and affects their prognosis. The truth is that in a lot of cases, CFS can be a relatively short lived condition and patients can expect some degree of recovery and will be able to return to their work. The prognosis for recovery varies enormously from one patient to the next. It is worse in older people, in people who also have a psychiatric condition (such as depression) and in those who have rigid beliefs that the disease is purely a physical illness. CFS is a multifactorial illness with psychiatric, behavioural and physical components.

Tied to this is the belief that CFS is not treatable. There is good evidence for three methods of treatment. Antidepressant medication produces improvement in many cases, whether or not the patient is also suffering with depression; cognitive behavioural therapy is also often successful, and a graded exercise programme also frequently helps.

Again, having misconceptions about treatment is a prognostic factor. The patients who are the most motivated to improve and who embrace all of these treatments are most likely to improve quickly and get back to work. On the other hand, those who refuse to contemplate that the illness might have anything other than a physical basis and therefore refuse these types of treatment, tend not to make good progress. Getting back to work is in itself therapeutic. This is especially the case if patients are supported by the employer and their occupational health practitioners. Return to work can by facilitated by reduced hours followed by a gradual increase in hours over a period of weeks or months, and by reduced or modified duties at work. Both a reduction in responsibility and a reduction in physically demanding duties can be helpful. Unfortunately relatively few employees have access to occupational health, especially if they work for smaller companies. Rest is a very important part of treatment especially in the early stages. However

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