Chronic fatigue syndrome What nurses need to know, 2020, Bush

[Andy]

Chronic fatigue syndrome (CFS) is a long-term, often misunderstood disorder that involves the nervous, immune, metabolic, endocrine, and digestive systems. This article describes the pathophysiology of CFS, signs and symptoms of CFS in adults, diagnostic criteria for CFS, and nursing considerations for patients with CFS.

Open access, https://journals.lww.com/nursing/Fu...ue_syndrome__What_nurses_need_to_know.15.aspx

 

[Barry]

Very good.

 

[Trish]

Generally pretty good, I think, though the treatment section is concerning:

On the brighter side, some studies of patients treated with hydrocortisone have shown positive results in the short term.11 Pharmacotherapy with dextroamphetamine, nefazodone, acetyl-l-carnitine, rintatolimod, and immunoglobulin each produced some improvements, but they did not have the epidemiologic significance to become the gold standard for the pharmacologic treatment of CFS.11

The main goal of treatment is helping patients improve their quality of life by symptom relief.2 Sleep disruption and pain are usually addressed first and may require a sleep or pain specialist. Epsom salt soaks, acupuncture, massage, yoga, and activity management are nonpharmacologic therapies that may be recommended.1,4

 

[Jonathan Edwards]

I don't like all this stuff about multi system disease and spurious things about metabolism, immune cells, spots in the brain and HPA axes. Why not be honest and say we know nothing about the pathophysiology. People get it into their head that they have a problem with energy metabolism or neuroinflammation and that feeds into the quack business.

 

[Trish]

Perhaps we are so accustomed to dreadful articles for health professionals, we are too ready to grab something that actually acknowledges that ME is a physical disease, and that specifically says CBT and GET are not recommended. Too easy then to overlook the unscientific stuff that creeps in.

The article would be rather short if it just said: ME is a physical disease, here's a list of the defining symptoms and most patients have other symptoms too. No one knows what causes it, what is happening physiologically, or how to treat it. But we do know CBT and GET are useless and likely to be harmful, and pacing is the patients' recommended management strategy.

 

[Barry]

Accepted it may have its shortcomings, but it does send a key message to health professionals that they need to seriously change the way they think of pwME. Some advocacy efforts will be flawed but let's not throw the baby out with the bathwater.

 

[DigitalDrifter]

The hallmark of CFS is debilitating fatigue that does not improve with rest and that cannot be explained by an underlying medical disorder

When will this myth end?

 

[Snow Leopard]

When will this myth end?

Presumably, when they finally understand the pathology and no one fits under the "cannot be explained by an underlying medical disorder" bit.

 

[Marky]

I don't like all this stuff about multi system disease and spurious things about metabolism, immune cells, spots in the brain and HPA axes. Why not be honest and say we know nothing about the pathophysiology. People get it into their head that they have a problem with energy metabolism or neuroinflammation and that feeds into the quack business.

I mean, they kinda did: "The pathophysiology of CFS, which is not well understood"

I guess the question is if one should conclude anything about what systems might be affected based on several studies that are not replicated. The answer is no I guess, but that's probably why IOM concluded it is a serious multi-systemic disease.

There is definitely a serious problem with energy, but ur right were not doing us any favors assuming its due to metabolism when we have to keep all possibilities open. It`s hard to think that metabolism is not affected though, but ideas like yours of ME being a signalling disease shows that there can be other options to our presumptions.

 

[Dolphin]

Minor quibbles:

chronic fatigue immunity deficiency syndrome

The correct term is "chronic fatigue immunity dysfunction syndrome"

The fatigue of CFS is not relieved by sleep due to disturbances in sleep rhythm or quantity. Consequently, many patients experience nighttime insomnia and daytime hypersomnia. 11

I'm not convinced that we know that the fatigue is not relieved by sleep due to disturbances in sleep rhythm or quantity

 

[rvallee]

I'm not convinced that we know that the fatigue is not relieved by sleep due to disturbances and sleep rhythm or quantity

I would rate my sleep over the past 2 years as about as good as it gets, as dutiful sleep hygiene as it gets. Makes no difference. Sleep is not a magical thing. Even if we're restricting to the concept of fatigue and nothing else, it's not any more alleviated in ME than it is in any other disease. This trope has to die, largely irrelevant.