Chronic fatigue syndrome (CFS) also known as myalgia encephalopathy is a long-term condition, which is estimated to affect one to two million Americans. This condition is associated with several symptoms such as sleep disturbances, fatigue, post exertional malaise and dysfunction of the autonomic nervous system. It is a chronic multisystem disorder characterized by unclear diagnoses and associated repercussions because of lack of formal education, ambiguous diagnostic tests, prejudice by the care providers, and prescribed cure. CFS is fundamentally a biological disorder of originating undiscovered cause, though has implications on immune response, hormonal control and oxidative stress. Even though some relationship between these morphological alterations has been discerned, the exact factor that governs this remains theoretical, and no casual connection has been pinpointed.
Epidemiology
Prevalence rates for CFS have ranged from 0.007 percent to 2.8 percent among adults in United States and from 0.006 percent to 3.0 percent in primary care. Investigations carried out between 1993 and 1999 described an incidence of 0.004 percent to 0.56 percent. However, studies dated from more recent times describe the 0.24 percent to 2.6 percent rate. In a 2004 study, Bierl and his colleagues estimated that as many as 2.2 million adults in America have CFS-like illness, or 1,197 per 1 lakh.
It is more common between persons from 40 to 70 years of age, and more women are affected than men. The illness appears to be more common in Whites than non-Whites. Other studies also reported that prevalence in low-income groups is considerably higher when compared with higher-income and better-educated groups. This might be an indication that risk factors like stress play a significant role in the development of CFS. Regional differences around the country in the prevalence of CFS have not been noted.
Anatomy
Pathophysiology
CFS is a condition characterized by changes in nervous system, immune system, autoimmune and neuroendocrinal responses to neurons, and oxidative stress. The disease is associated with an altered interleukin profile and functioning of NK cell, reduced response of T cells towards specific antigens. Documentation of ongoing inflammation is indicated by the elevated production of various proinflammatory interleukins, which also explains the presence of symptoms resembling flu and malaise.
Recent publications describe an increase in oxidative stress in patients with CFS, very important to the physiopathology of this disease. This will transform or alter fatty acid and protein damage into immunogenic targets that further destroy the ETC (electron transport chain) and mitochondria. The mechanism of mitochondrial dysregulation is not fully known.
The activation of the RNase/ L 2′5′-oligoadenylate synthetase pathway is associated with the onset of this condition, which suppresses the apoptotis in cells. The tests showed a reduced amount of CD3 to CD57 white cell lymphocytes which showed normal cytotoxic T cells.
There is also B cell impairment noted in CFS patients, where there is increased CD5+ CD20+ B cell phenotype production and CD21 marker overexpression acting as receptors for some viruses. The numbers and distribution of the types of immunoglobulins are also altered in CFS patients, with lower total IgG levels and increased IgA and IgM serum levels against lipopolysaccharides of normal gram-negative bacteria due to gut permeability alterations.
In CFS patients, there is a detection of autoimmunity, which alters neurotransmitter response and sleep patterns and neurocognition. Neuronal sensitization is the hypothetical exaggerated response to painful stimuli in CFS patients resulting from chemical and structural changes at the level of the central nervous system.
These changes at the level of the neuroendocrine system include serotonin transmission, hypothalamic-pituitary axis dysfunction, and genetic predisposition. All these factors together, as mentioned above, lead to the development of this disorder, thus accounting for the overall health problems of CFS patients.
Etiology
There are a number of complicated and controversial theories linked to infections, immunity, and genetics regarding chronic fatigue syndrome. Genetic background and susceptibility are increasingly supported by studies on family history and genetic predisposition. Variability in gene expression, mainly after exercise, influences metabolism and immune responses. Infections—like Epstein-Barr virus, human herpesvirus 6, and human parvovirus B19—are hypothesized to trigger the disease. Studies have detected anti-HHV-6 IgM antibodies and HHV-6 antigens in the peripheral blood of CFS patients more frequently than in the general population. Evidence has pointed toward parvovirus B19 as an agent in the development and provocation of CFS. The immune system is changed, with changes in CD 21+ CD19+ and activated CD5+ cells, diminished transitory B cells and plasmablasts, and a rise in CD24+ B cells. Noticeably, an increase in the level of immunoglobulins IgG and autoantibodies against nuclear and membranous structures and receptors of neurotransmitters may be increased.
Genetics
Prognostic Factors
This condition may persist for a longer period and has no cure. It’s clinical course fluctuates between remissions and relapses, with 50% of patients returning to work. Poor prognosis is linked to comorbid depression, anxiety, longer duration of illness, and severe fatigue. Positive outcomes include less severity of fatigue, no physical cause or better control of symptoms.
Clinical History
Around 25% of CFS patients are bed ridden or house-bound, often due to a history of flu-like infection. Short-term memory problems are common, but long-term memory issues are not. Verbal dyslexia, a difficulty in finding or saying a word during normal speech, can also interfere with CFS patients’ occupation and cause disturbance.
Five main symptoms as explained by the National Academy of Medicine include:
Reduced or impaired ability to perform daily routine
Unrefreshing sleep
Orthostatic intolerance
Post exertional malaise
Cognitive impairment
Physical Examination
Physical examination is often unrevealing. Some patients may have positive orthostatic vital signs.
Many patients without or with CFS have small, painless and movable lymph nodes that most commonly involve the axillary region, inguinal region, or neck. A single lymph node that is tender, immobile, or very large suggests a diagnosis other than CFS. Similar, generalized adenopathy suggest a diagnosis other than CFS.
In the oropharynx, crimson or purple crescent discoloration of both anterior tonsillar pillars in the absence of pharyngitis is a common marker in patients with CFS. The etiology of crimson crescents is yet unknown, but they are very common in patients with CFS. However, crimson crescents are not specific for CFS.
Trigger points, which suggest fibromyalgia, are absent in patients with CFS. Fibromyalgia and CFS rarely coexist in the same patient.
CFS is s complex illness, requiring multi-dimensional treatment. It consists of detailed assessment and medical investigation, symptom management, nutritional supplementation, physical rehabilitation, alternative and complementary therapies, and education of patients along with long-term follow-up.
The goal is to help patients manage their symptoms effectively and improve quality of life. The treatment paradigm is tailored to individual patient ensuring that they receive the best possible care.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
modification-of-the-environment
Non-pharmacological management
Treatment of chronic fatigue syndrome is controversial, but a 2011 UK randomised control trial evidenced that CBT, APT, GET, and specialist medical care each improved results when used in combination. However, the CDC recommended that depression, anxiety, and stress should be treated, but not CFS. Yoga, deep breathing, massage, tai chi, and muscle relaxation probably are of benefit. CBT and GET are, therefore, adjunct management choices and may not cure. Activity management, otherwise known as pacing, is intended to balance activity and rest to prevent flared states of intolerant exercise.
Use of NSAIDs
COX-2 inhibitors:
These drugs help to reduce pain and inflammation associated with the disease.
Use of tricyclic antidepressants
These medications can be employed to improve severity of fatigue, sleep and pian levels. Lower doses than that used for depression are preferred.
Use of SSRIs and SNRIs
Many drugs like paroxetine, fluoxetine, and sertraline can be used to overcome anxiety and depression which may occur as a disease consequence or accompany the disease process.
intervention-with-a-procedure
Fecal microbiotal transplantation (FMT)
Modification of microbiota in GI in patients with CFS has been a part of postulated etiologies. FMT is an exciting and reltively safe treatment modality currently being tested in management of various conditions along with CFS. This process includes transferring feces into the gut of a patient from healthy donor. Recent studies have shown significant symptomatic relief in patients following FMT, offering promising insights into therapy.
CFS, also known as myalgic encephalomyelitis or ME, is a chronic condition for which a comprehensive medical evaluation is necessary for diagnosis and management. The symptoms may include persistent fatigue, pain, cognitive malfunction, and sleeping disorders. Comorbidities will need to be treated concomitantly. A health expert personalizes the treatment strategy with regards to his or her dominating symptoms, needs, and lifestyle. Patients are informed about the disorder CFS/ME and its symptoms, possible triggering factors, and management methodologies. Symptom management include modalities for pacing and the “energy envelope” theory to balance activity and rest. Pain and sleep management involves addressing sleep disturbances with good sleep practices and medications or supplements. Medications are prescribed to manage specific symptoms. Psychological and emotional support is provided through CBT (cognitive-behavioural therapy), support groups, and counselling. Physical rehabilitation through Graded Exercise therapy, with emphasis on graduated return to physical activity. Nutritional and lifestyle support will provide balanced nutrition, hydration, and lifestyle alterations. Aid in participating in research adds to greater understanding of CFS/ME and the development of new treatments.
Chronic fatigue syndrome (CFS) also known as myalgia encephalopathy is a long-term condition, which is estimated to affect one to two million Americans. This condition is associated with several symptoms such as sleep disturbances, fatigue, post exertional malaise and dysfunction of the autonomic nervous system. It is a chronic multisystem disorder characterized by unclear diagnoses and associated repercussions because of lack of formal education, ambiguous diagnostic tests, prejudice by the care providers, and prescribed cure. CFS is fundamentally a biological disorder of originating undiscovered cause, though has implications on immune response, hormonal control and oxidative stress. Even though some relationship between these morphological alterations has been discerned, the exact factor that governs this remains theoretical, and no casual connection has been pinpointed.
Prevalence rates for CFS have ranged from 0.007 percent to 2.8 percent among adults in United States and from 0.006 percent to 3.0 percent in primary care. Investigations carried out between 1993 and 1999 described an incidence of 0.004 percent to 0.56 percent. However, studies dated from more recent times describe the 0.24 percent to 2.6 percent rate. In a 2004 study, Bierl and his colleagues estimated that as many as 2.2 million adults in America have CFS-like illness, or 1,197 per 1 lakh.
It is more common between persons from 40 to 70 years of age, and more women are affected than men. The illness appears to be more common in Whites than non-Whites. Other studies also reported that prevalence in low-income groups is considerably higher when compared with higher-income and better-educated groups. This might be an indication that risk factors like stress play a significant role in the development of CFS. Regional differences around the country in the prevalence of CFS have not been noted.
CFS is a condition characterized by changes in nervous system, immune system, autoimmune and neuroendocrinal responses to neurons, and oxidative stress. The disease is associated with an altered interleukin profile and functioning of NK cell, reduced response of T cells towards specific antigens. Documentation of ongoing inflammation is indicated by the elevated production of various proinflammatory interleukins, which also explains the presence of symptoms resembling flu and malaise.
Recent publications describe an increase in oxidative stress in patients with CFS, very important to the physiopathology of this disease. This will transform or alter fatty acid and protein damage into immunogenic targets that further destroy the ETC (electron transport chain) and mitochondria. The mechanism of mitochondrial dysregulation is not fully known.
The activation of the RNase/ L 2′5′-oligoadenylate synthetase pathway is associated with the onset of this condition, which suppresses the apoptotis in cells. The tests showed a reduced amount of CD3 to CD57 white cell lymphocytes which showed normal cytotoxic T cells.
There is also B cell impairment noted in CFS patients, where there is increased CD5+ CD20+ B cell phenotype production and CD21 marker overexpression acting as receptors for some viruses. The numbers and distribution of the types of immunoglobulins are also altered in CFS patients, with lower total IgG levels and increased IgA and IgM serum levels against lipopolysaccharides of normal gram-negative bacteria due to gut permeability alterations.
In CFS patients, there is a detection of autoimmunity, which alters neurotransmitter response and sleep patterns and neurocognition. Neuronal sensitization is the hypothetical exaggerated response to painful stimuli in CFS patients resulting from chemical and structural changes at the level of the central nervous system.
These changes at the level of the neuroendocrine system include serotonin transmission, hypothalamic-pituitary axis dysfunction, and genetic predisposition. All these factors together, as mentioned above, lead to the development of this disorder, thus accounting for the overall health problems of CFS patients.
There are a number of complicated and controversial theories linked to infections, immunity, and genetics regarding chronic fatigue syndrome. Genetic background and susceptibility are increasingly supported by studies on family history and genetic predisposition. Variability in gene expression, mainly after exercise, influences metabolism and immune responses. Infections—like Epstein-Barr virus, human herpesvirus 6, and human parvovirus B19—are hypothesized to trigger the disease. Studies have detected anti-HHV-6 IgM antibodies and HHV-6 antigens in the peripheral blood of CFS patients more frequently than in the general population. Evidence has pointed toward parvovirus B19 as an agent in the development and provocation of CFS. The immune system is changed, with changes in CD 21+ CD19+ and activated CD5+ cells, diminished transitory B cells and plasmablasts, and a rise in CD24+ B cells. Noticeably, an increase in the level of immunoglobulins IgG and autoantibodies against nuclear and membranous structures and receptors of neurotransmitters may be increased.
This condition may persist for a longer period and has no cure. It’s clinical course fluctuates between remissions and relapses, with 50% of patients returning to work. Poor prognosis is linked to comorbid depression, anxiety, longer duration of illness, and severe fatigue. Positive outcomes include less severity of fatigue, no physical cause or better control of symptoms.
Around 25% of CFS patients are bed ridden or house-bound, often due to a history of flu-like infection. Short-term memory problems are common, but long-term memory issues are not. Verbal dyslexia, a difficulty in finding or saying a word during normal speech, can also interfere with CFS patients’ occupation and cause disturbance.
Five main symptoms as explained by the National Academy of Medicine include:
Reduced or impaired ability to perform daily routine
Unrefreshing sleep
Orthostatic intolerance
Post exertional malaise
Cognitive impairment
Physical examination is often unrevealing. Some patients may have positive orthostatic vital signs.
Many patients without or with CFS have small, painless and movable lymph nodes that most commonly involve the axillary region, inguinal region, or neck. A single lymph node that is tender, immobile, or very large suggests a diagnosis other than CFS. Similar, generalized adenopathy suggest a diagnosis other than CFS.
In the oropharynx, crimson or purple crescent discoloration of both anterior tonsillar pillars in the absence of pharyngitis is a common marker in patients with CFS. The etiology of crimson crescents is yet unknown, but they are very common in patients with CFS. However, crimson crescents are not specific for CFS.
Trigger points, which suggest fibromyalgia, are absent in patients with CFS. Fibromyalgia and CFS rarely coexist in the same patient.
CFS is s complex illness, requiring multi-dimensional treatment. It consists of detailed assessment and medical investigation, symptom management, nutritional supplementation, physical rehabilitation, alternative and complementary therapies, and education of patients along with long-term follow-up.
The goal is to help patients manage their symptoms effectively and improve quality of life. The treatment paradigm is tailored to individual patient ensuring that they receive the best possible care.
Infectious Disease
Non-pharmacological management
Treatment of chronic fatigue syndrome is controversial, but a 2011 UK randomised control trial evidenced that CBT, APT, GET, and specialist medical care each improved results when used in combination. However, the CDC recommended that depression, anxiety, and stress should be treated, but not CFS. Yoga, deep breathing, massage, tai chi, and muscle relaxation probably are of benefit. CBT and GET are, therefore, adjunct management choices and may not cure. Activity management, otherwise known as pacing, is intended to balance activity and rest to prevent flared states of intolerant exercise.
Infectious Disease
COX-2 inhibitors:
These drugs help to reduce pain and inflammation associated with the disease.
Infectious Disease
These medications can be employed to improve severity of fatigue, sleep and pian levels. Lower doses than that used for depression are preferred.
Infectious Disease
Many drugs like paroxetine, fluoxetine, and sertraline can be used to overcome anxiety and depression which may occur as a disease consequence or accompany the disease process.
Infectious Disease
Fecal microbiotal transplantation (FMT)
Modification of microbiota in GI in patients with CFS has been a part of postulated etiologies. FMT is an exciting and reltively safe treatment modality currently being tested in management of various conditions along with CFS. This process includes transferring feces into the gut of a patient from healthy donor. Recent studies have shown significant symptomatic relief in patients following FMT, offering promising insights into therapy.
Infectious Disease
CFS, also known as myalgic encephalomyelitis or ME, is a chronic condition for which a comprehensive medical evaluation is necessary for diagnosis and management. The symptoms may include persistent fatigue, pain, cognitive malfunction, and sleeping disorders. Comorbidities will need to be treated concomitantly. A health expert personalizes the treatment strategy with regards to his or her dominating symptoms, needs, and lifestyle. Patients are informed about the disorder CFS/ME and its symptoms, possible triggering factors, and management methodologies. Symptom management include modalities for pacing and the “energy envelope” theory to balance activity and rest. Pain and sleep management involves addressing sleep disturbances with good sleep practices and medications or supplements. Medications are prescribed to manage specific symptoms. Psychological and emotional support is provided through CBT (cognitive-behavioural therapy), support groups, and counselling. Physical rehabilitation through Graded Exercise therapy, with emphasis on graduated return to physical activity. Nutritional and lifestyle support will provide balanced nutrition, hydration, and lifestyle alterations. Aid in participating in research adds to greater understanding of CFS/ME and the development of new treatments.
Chronic fatigue syndrome (CFS) also known as myalgia encephalopathy is a long-term condition, which is estimated to affect one to two million Americans. This condition is associated with several symptoms such as sleep disturbances, fatigue, post exertional malaise and dysfunction of the autonomic nervous system. It is a chronic multisystem disorder characterized by unclear diagnoses and associated repercussions because of lack of formal education, ambiguous diagnostic tests, prejudice by the care providers, and prescribed cure. CFS is fundamentally a biological disorder of originating undiscovered cause, though has implications on immune response, hormonal control and oxidative stress. Even though some relationship between these morphological alterations has been discerned, the exact factor that governs this remains theoretical, and no casual connection has been pinpointed.
Prevalence rates for CFS have ranged from 0.007 percent to 2.8 percent among adults in United States and from 0.006 percent to 3.0 percent in primary care. Investigations carried out between 1993 and 1999 described an incidence of 0.004 percent to 0.56 percent. However, studies dated from more recent times describe the 0.24 percent to 2.6 percent rate. In a 2004 study, Bierl and his colleagues estimated that as many as 2.2 million adults in America have CFS-like illness, or 1,197 per 1 lakh.
It is more common between persons from 40 to 70 years of age, and more women are affected than men. The illness appears to be more common in Whites than non-Whites. Other studies also reported that prevalence in low-income groups is considerably higher when compared with higher-income and better-educated groups. This might be an indication that risk factors like stress play a significant role in the development of CFS. Regional differences around the country in the prevalence of CFS have not been noted.
CFS is a condition characterized by changes in nervous system, immune system, autoimmune and neuroendocrinal responses to neurons, and oxidative stress. The disease is associated with an altered interleukin profile and functioning of NK cell, reduced response of T cells towards specific antigens. Documentation of ongoing inflammation is indicated by the elevated production of various proinflammatory interleukins, which also explains the presence of symptoms resembling flu and malaise.
Recent publications describe an increase in oxidative stress in patients with CFS, very important to the physiopathology of this disease. This will transform or alter fatty acid and protein damage into immunogenic targets that further destroy the ETC (electron transport chain) and mitochondria. The mechanism of mitochondrial dysregulation is not fully known.
The activation of the RNase/ L 2′5′-oligoadenylate synthetase pathway is associated with the onset of this condition, which suppresses the apoptotis in cells. The tests showed a reduced amount of CD3 to CD57 white cell lymphocytes which showed normal cytotoxic T cells.
There is also B cell impairment noted in CFS patients, where there is increased CD5+ CD20+ B cell phenotype production and CD21 marker overexpression acting as receptors for some viruses. The numbers and distribution of the types of immunoglobulins are also altered in CFS patients, with lower total IgG levels and increased IgA and IgM serum levels against lipopolysaccharides of normal gram-negative bacteria due to gut permeability alterations.
In CFS patients, there is a detection of autoimmunity, which alters neurotransmitter response and sleep patterns and neurocognition. Neuronal sensitization is the hypothetical exaggerated response to painful stimuli in CFS patients resulting from chemical and structural changes at the level of the central nervous system.
These changes at the level of the neuroendocrine system include serotonin transmission, hypothalamic-pituitary axis dysfunction, and genetic predisposition. All these factors together, as mentioned above, lead to the development of this disorder, thus accounting for the overall health problems of CFS patients.
There are a number of complicated and controversial theories linked to infections, immunity, and genetics regarding chronic fatigue syndrome. Genetic background and susceptibility are increasingly supported by studies on family history and genetic predisposition. Variability in gene expression, mainly after exercise, influences metabolism and immune responses. Infections—like Epstein-Barr virus, human herpesvirus 6, and human parvovirus B19—are hypothesized to trigger the disease. Studies have detected anti-HHV-6 IgM antibodies and HHV-6 antigens in the peripheral blood of CFS patients more frequently than in the general population. Evidence has pointed toward parvovirus B19 as an agent in the development and provocation of CFS. The immune system is changed, with changes in CD 21+ CD19+ and activated CD5+ cells, diminished transitory B cells and plasmablasts, and a rise in CD24+ B cells. Noticeably, an increase in the level of immunoglobulins IgG and autoantibodies against nuclear and membranous structures and receptors of neurotransmitters may be increased.
This condition may persist for a longer period and has no cure. It’s clinical course fluctuates between remissions and relapses, with 50% of patients returning to work. Poor prognosis is linked to comorbid depression, anxiety, longer duration of illness, and severe fatigue. Positive outcomes include less severity of fatigue, no physical cause or better control of symptoms.
Around 25% of CFS patients are bed ridden or house-bound, often due to a history of flu-like infection. Short-term memory problems are common, but long-term memory issues are not. Verbal dyslexia, a difficulty in finding or saying a word during normal speech, can also interfere with CFS patients’ occupation and cause disturbance.
Five main symptoms as explained by the National Academy of Medicine include:
Reduced or impaired ability to perform daily routine
Unrefreshing sleep
Orthostatic intolerance
Post exertional malaise
Cognitive impairment
Physical examination is often unrevealing. Some patients may have positive orthostatic vital signs.
Many patients without or with CFS have small, painless and movable lymph nodes that most commonly involve the axillary region, inguinal region, or neck. A single lymph node that is tender, immobile, or very large suggests a diagnosis other than CFS. Similar, generalized adenopathy suggest a diagnosis other than CFS.
In the oropharynx, crimson or purple crescent discoloration of both anterior tonsillar pillars in the absence of pharyngitis is a common marker in patients with CFS. The etiology of crimson crescents is yet unknown, but they are very common in patients with CFS. However, crimson crescents are not specific for CFS.
Trigger points, which suggest fibromyalgia, are absent in patients with CFS. Fibromyalgia and CFS rarely coexist in the same patient.
CFS is s complex illness, requiring multi-dimensional treatment. It consists of detailed assessment and medical investigation, symptom management, nutritional supplementation, physical rehabilitation, alternative and complementary therapies, and education of patients along with long-term follow-up.
The goal is to help patients manage their symptoms effectively and improve quality of life. The treatment paradigm is tailored to individual patient ensuring that they receive the best possible care.
Infectious Disease
Non-pharmacological management
Treatment of chronic fatigue syndrome is controversial, but a 2011 UK randomised control trial evidenced that CBT, APT, GET, and specialist medical care each improved results when used in combination. However, the CDC recommended that depression, anxiety, and stress should be treated, but not CFS. Yoga, deep breathing, massage, tai chi, and muscle relaxation probably are of benefit. CBT and GET are, therefore, adjunct management choices and may not cure. Activity management, otherwise known as pacing, is intended to balance activity and rest to prevent flared states of intolerant exercise.
Infectious Disease
COX-2 inhibitors:
These drugs help to reduce pain and inflammation associated with the disease.
Infectious Disease
These medications can be employed to improve severity of fatigue, sleep and pian levels. Lower doses than that used for depression are preferred.
Infectious Disease
Many drugs like paroxetine, fluoxetine, and sertraline can be used to overcome anxiety and depression which may occur as a disease consequence or accompany the disease process.
Infectious Disease
Fecal microbiotal transplantation (FMT)
Modification of microbiota in GI in patients with CFS has been a part of postulated etiologies. FMT is an exciting and reltively safe treatment modality currently being tested in management of various conditions along with CFS. This process includes transferring feces into the gut of a patient from healthy donor. Recent studies have shown significant symptomatic relief in patients following FMT, offering promising insights into therapy.
Infectious Disease
CFS, also known as myalgic encephalomyelitis or ME, is a chronic condition for which a comprehensive medical evaluation is necessary for diagnosis and management. The symptoms may include persistent fatigue, pain, cognitive malfunction, and sleeping disorders. Comorbidities will need to be treated concomitantly. A health expert personalizes the treatment strategy with regards to his or her dominating symptoms, needs, and lifestyle. Patients are informed about the disorder CFS/ME and its symptoms, possible triggering factors, and management methodologies. Symptom management include modalities for pacing and the “energy envelope” theory to balance activity and rest. Pain and sleep management involves addressing sleep disturbances with good sleep practices and medications or supplements. Medications are prescribed to manage specific symptoms. Psychological and emotional support is provided through CBT (cognitive-behavioural therapy), support groups, and counselling. Physical rehabilitation through Graded Exercise therapy, with emphasis on graduated return to physical activity. Nutritional and lifestyle support will provide balanced nutrition, hydration, and lifestyle alterations. Aid in participating in research adds to greater understanding of CFS/ME and the development of new treatments.
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