Posts Tagged ‘Cognitive behavioral therapy’

Treatment for ME/ CFS – Dr Vinod Patel

August 13, 2011 1 comment


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“The main treatments that I find useful are as follows, however, it must be pointed out that none or all of these treatments may work in any specific patient and indeed, a lot of the treatments listed below do not work at all in some specific patients. I can definitely conclude that at least 50% of my patients have benefited from the treatments below, either in isolation or with one or more of the other treatments in the list.

  • Pacing; Pacing allows patients to use their energy levels “wisely”. If, for example, I am capable of doing a 45 minute brisk walk during the day, there is absolutely no way that I would not suffer after doing a 2 hour brisk walk. It is therefore particularly important to know the limits of ones physical activity. I have found that a pedometer works in some patients to work out personal limits.
  • Amitriptyline; Low dose Amitriptyline at night often helps with sleep and also reduces night pain.
  • Nortriptyline; Nortriptyline is a treatment that is related to Amitriptyline, however it probably has better efficacy in moderate to severe fibromyalgia. It also allows a better quality sleep at night. Clearly if patients have side-effects such as sedation, it may well be that Nortriptyline or Amitriptyline is only used at night (or not at all).
  • Gabapentin; Gabapentin is very useful, as is Amitriptyline and Nortriptyline, for neuropathic pain. I have also used Gabapentin for myoclonic jerks in patients to good effect.
  • Melatonin; Melatonin is a very interesting agent and is a natural sleep hormone that we all have. Melatonin is very useful in patients with a poor sleep pattern. I normally only use 2 -5mg at night, 4 days a week, so that the patient does not become dependant on Melatonin. In some patients there has been a dramatic improvement. Other drugs such as Zopiclone can also be used to improve sleep.
  • Duloextine; Duloextine is very good for severe neuropathic pain. It also has anti-depressant actions (as do Amitriptyline and Nortriptyline to some extent). This relatively new agent has had a dramatic effect in one or two of my most severely affected patients with neuropathic pain or even very severe fibromyalgia.
  • Testosterone Replacement; Testosterone replacement has been helpful in both men and women to give stamina and often a positive general outlook.This can only be used in patients who have low testosterone levels which have been tested at least twice. In the majority of cases treatment can be given with injections or a gel.
  • Cognitive Behavioural Therapy; Cognitive behavioural therapy also helps many patients, however, its availability is very limited locally.

Treatments are often based around diagnosing specific conditions that can mimic ME/CFS. These include the following:

  • Thyroid disorders: treated with thyroxin or thionamides.
  • Adrenal Insufficiency: treated with low dose steroids.
  • Postural Hypotension treated with fludrocortisone.
  • Low testosterone states as above.
  • Calcium disorders: treated with calcium, vitamin D.
  • Coeliac Disease: treated by eliminating gluten from diet.
  • B12/Folate deficiency: treated by replacement of these vitamins.
  • Pyridoxine supplementation: especially if symptoms relate to periods.
  • Low potassium states: treated by diet and or potassium replacement.
  • Myasthenia Gravis: specific disorder of neuro-muscular junctions.
  • Systemic Lupus Erythematosus: treated by rheumatologists.
  • Reactive Hypoglycaemia: low glucose states treated by diet.
  • Depression and Neuropathic: a rare diagnosis, citalopram useful.
  • Sleep Apnoea: treated specifically with weight loss and special mask.
  • Obesity: carrying extra weight can increase tiredness.
  • Rheumatological Disorders: specific diagnosis and treatment.

It is also important to stop certain drugs that cause tiredness, for example, statins, codeine, Tramadol, other pain killers, cannabis. At this point I would also like to state it is very difficult to give general advice on pacing and I prefer that the majority of our patients are seen by our Occupational Therapist or Physiotherapist for specific personalised advice on pacing after a detailed history on activities of daily living and physical activity patterns is established.”

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