Take Home Messages:

There is no single cause of chronic fatigue syndrome.

The most effective treatments for chronic fatigue are cognitive behaviour therapy (CBT) and graded exercise therapy.

Prolonged rest is not an effective treatment for chronic fatigue.

Chronic fatigue is not a dead end in terms of employment. Return to work is possible for sufferers of chronic fatigue syndrome.

Employers and health professionals both have important roles to play in helping chronic fatigue sufferers get back into the workplace. It is vital to:

• Educate the patient about striking an appropriate balance between exertion and rest;
• Collaborate with the patient to develop a tailored return to work plan;
• Be flexible about working hours;
• Foster a supportive workplace; and

Ensure that workers take appropriate breaks.

Why the research matters:

The bad new is: chronic fatigue syndrome and its accompanying sick leave cost organisations money and take a huge toll on sufferers.

The good news is: recovery is possible!

What the research involved:

The researchers surveyed the literature on causes and methods of treatment for chronic fatigue syndrome. They then summarised the information, and assessed how well each method of treatment performed.

Summary of research findings:

The research findings can be divided into five sections:

1. Causes

No single cause of chronic fatigue syndrome has been identified. Factors which may contribute to the onset and duration of fatigue include:

1. An infection such as glandular fever, hepatitis or viral meningitis. Persistence of the virus does not seem to cause the chronic problems. Rather, the initial infection seems to act as a stressor;
2. Difficult life experiences in the months prior to the onset of fatigue;
3. Unhelpful coping responses to acute fatigue, such as an immediate return to extreme physical activity after illness, or excessive rest and convalescence, or alternating between the two extremes (excessive activity and excessive rest) on a day to day basis;
4. Emotional factors like stress, anxiety and depression;
5. Cognitive habits such as catastrophic beliefs and a tendency to attend to bodily sensations;
6. Interpersonal factors such as a perception that social support is lacking and unhelpful responses to the onset of fatigue from friends, family and workmates.

2.  Treatment

Treatments for chronic fatigue syndrome include cognitive behaviour therapy (CBT), graded exercise therapy (GET), medication, immunological intervention, complementary / alternative therapies, nutritional supplements and prolonged rest.

The most successful treatments are:

1. Cognitive behaviour therapy. CBT involves making a constructive plan to deal with symptoms and working to restructure unhelpful beliefs and assumptions; and
2. Graded exercise therapy. GET involves a structured and gradual increase in aerobic activities, for example walking.

There is no evidence that prolonged rest is an effective treatment for chronic fatigue. In fact, prolonged rest has been shown to perpetuate or even increase fatigue in both healthy volunteers and people recovering from a virus.

Treatment with medication has mixed results but in general is of little or no help:

1. Antidepressants do not have significant benefits;
2. Some corticosteroids (hydrocortisone) give a short term improvement in fatigue and on a self-rated scale of wellness but others (fludrocortisone) show no beneficial effects; and
3. Other pharmacological interventions have either limited benefit (oral nicotinamide adenine dinucleotide), no overall benefit (selegiline), no effect (moclobemide, sulbutiamine, galanthamine hybromide and growth hormone) or negative effect (acyclovir).

Studies of treatment via immunological interventions, complementary / alternative therapies and nutritional supplements were either inconclusive, contradictory, or poorly conducted.

3.  Information for return to work doctors

There is no diagnostic test for chronic fatigue syndrome. However investigations can be helpful in excluding other medical problems.

Working with the patient to develop a treatment plan can assist with recovery by helping the patient strike the right balance between activity and rest.

It can also be beneficial to educate the patient about the stress response, anxiety and depression. Where appropriate, refer the patient to a psychologist or psychiatrist.

4.  Fatigue and work

Workplace issues which can exacerbate fatigue include:

1. Long or irregular working hours;
2. Failure to take breaks;
3. A heavy workload combined with a decreased ability to cope; and
4. Lack of understanding from managers and colleagues.

5.  Return to work is possible

Return to work is best achieved by liaison between the patient, his / her manager, Occupational Health and Human Resources.

1. Good planning is essential for a successful return to work. A return to work plan may include elements such as:
2. A period in which the person works from home, or takes up a volunteer position elsewhere, in order to build up skills and confidence;
3. A gradual increase in the number of hours worked;
4. Flexibility about work schedules;
5. Provision for regular breaks; and
6. Regular reviews of progress.

Original research:

Treatments for Chronic Fatigue Syndrome
Rimes KA, Chalder T.
Occupational Medicine;55:32-9. 2005

Link to PubMed abstract