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Creating a Treatment Plan

Before we lay out treatment options for the main symptoms of CFS and FM, we offer an example of creating a symptom treatment plan by describing how Dr. Campbell created his approach to fatigue, the most persistent and disruptive symptom of his CFS.

He started by listing possible causes of his fatigue beyond CFS and then evaluating each one:

1. Activity level (overexertion)
2. Pain
3. Poor sleep
4. Inactivity
5. Stress
6. Depression
7. Poor nutrition
8. Medications

Activity Level

Activity level seemed the most crucial. There was an obvious connection between the amount of activity and fatigue, though the effects were sometimes delayed a day or two. Given the strong the connection between activity and fatigue, he reasoned that he might gain some control if he found a level of activity that his body could tolerate.

He then spent a lot of time determining his limits, adjusting his life to fit within them, and periodically trying small experiments to expand his activity level. (For more, see the chapters on pacing in his recovery story.)

Inactivity (De-conditioning)

Beyond activity level, the other factor that seemed especially promising was inactivity. Even athletes become deconditioned if they stop exercising for even a brief time, so he believed part of his fatigue was due to his lower activity level and that the way to fight this was through exercise. He experimented to find the length and intensity of exercise that produced an aerobic workout without increasing his symptoms.

Sleep and Pain

Improving his sleep also seemed worth pursuing. He focused on maintaining good sleep habits such as having regular times to go to bed at night and to get up in the morning. He also made use of a wind down period in the evening, turning off the TV and stop using the computer at 9 pm.

A final factor he thought might be affecting his fatigue was pain: responding to pain by tensing up might increase fatigue. He added a regular relaxation procedure to his daily rests.

Stress, Nutrition and Medications

A year or so into his experience of CFS, he came to believe that stress was second only to overexertion as an intensifier of symptoms. As a result, he added both stress reduction and stress avoidance strategies to his management plan. Also, over time he came to recognize the role of emotions in CFS and incorporated self-management strategies to address that area.

Lastly, he assumed that the final two factors on his list of possible causes of fatigue didn’t apply to him. Since he had decided not to take medications to treat his CFS, he was not worried about fatigue due to drugs. And he believed his nutrition was adequate.

Two Principles and a Strategy
His approach to fatigue illustrates two principles of symptom management in CFS and FM. First, because a symptom can have multiple causes, it’s often helpful to use multiple strategies in response. And, second, finding what works often takes experimentation.

To create your symptom management plan, we suggest you work on one symptom at a time, beginning with the one that is most bothersome. To proceed, list and evaluate your options. Settle on one or two and try it or them, then evaluate the results. Based on the results, refine your strategies or try new ones. 

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