Article 14-CFS

14: PHARMACOLOGICAL APPROACHES TO CHRONIC FATIGUE SYNDROME
The search for a precise and complete pharmacological treatment to chronic fatigue
syndrome (CFS) has led experts to recurrently conduct controlled experiments, scientific
research, and clinical trials with the hope that these studies will lead to a plausible answer which
can be deemed as a medical breakthrough. Since there is the need to streamline the diagnosis of
CFS and its causes, the demand for a universal solution to this disorder becomes even more
insistent. Several medications were tested. Still, there is the paucity of medical findings that will
provide absolute resolution to this condition.1
Despite several attempts, no particular drug for the cure of CFS has ever been qualified
for the approval of the U.S. Food and Drug Administration (FDA).2 At present, scientists are still
in the trial phase and FDA has yet to find a drug that will pass it standards without reservation. In
spite of the lack of pharmacological treatment for CFS, medications are still prescribed to
patients; not to combat CFS, but to deal with its symptoms, such as fatigue, low blood pressure,
sleep disorder, depression, pain, and other abnormalities brought about by the syndrome.
In a study conducted among CFS patients, results showed that the use of medication
among these patients was high even when the effectiveness of such pharmacological drugs to
treat CFS overall was not yet determined. A number of patients who turned to prescription
treatment reported that after their intake, they experienced lesser somatic symptoms that are
linked to CFS.3
In Georgia, a survey denoted that over 90% of the subjects who have CFS were taking at
least one medication in the two-week period before the study was run.4 The findings implied
that the use of medication was beneficial in relieving CFS patients, even on a temporary basis,

from the discomforts of the symptoms that they had been suffering due to the syndrome.
Similarly, a survey held in Kansas revealed that participants with CFS used 316 several drugs,
often multiple treatments, vis-à-vis the 157 medications used by non-fatigued individuals.5
Benefits and Pitfalls on the Use of Pharmacological Treatment
Even with the availability of other forms of treatment, there is the advantage of adopting
pharmaceutical approaches in dealing with the symptoms of CFS because these medical agents
were subjected to laboratory tests and protocols. Prescribed medicines went through a rigid
process of research and controlled experimentation to ensure that these products would yield
positive results to the wellbeing of the patient. Scientists who are honed in the medical discipline
carefully studied the creation, processes, and validities of pharmacological drugs, which are
substantiated by a body of experts, before they are released to the public.
It cannot be ruled out that as no complete cure to CFS has been identified yet,
pharmacological treatment of its symptoms is still limited and even subject to error. There are
some shortfalls to the studies of these treatments. Among these constraints are the unique
responses of CFS patients to certain drugs; the length of time before patients can respond to a
particular treatment; varying reactions to these treatments that can alter over a period of time;
and a variety of results that may not be connected to the substance that is being taken by the
patient.6 Other drugs can produce a yo-yo effect to patients while withdrawal can be more
arduous than expected. In other randomized controlled trials (RCTs), there are drugs prescribed
to CFS patients that showed no significant effect after the treatment and does not lead to any
progress to altogether eradicate CFS or its symptoms.7

Another important note on prescription medicines is the possibility of patients to be
dependent on the prescribed drugs. Symptoms of CFS can wane even without the aid of
medications, which makes it necessary for patients to constantly observe and record their
symptoms and consult experts for possible shift of treatment strategies.
The downside of taking prescription medicines is the possible adverse effects of these
medications on some patients as their bodies react differently to these drugs. Continued use may
cause new symptoms to arise or complicate existing ones. Physicians, including patients and
their family members, need to be vigilant and discerning on the right solutions to the various
symptoms and update themselves on clinical data as new research results emerge from time to
time. Other drugs, which may appear beneficial to patients on the onset, can also be perilous in
the long run. Past experiments, when repeated, may later on reveal serious consequence to the
condition of CFS patients that can jeopardize their health rather than lead to full recovery.
An additional stumbling block of using pharmacological medications is the cost of the
treatments. Worst of all, these expenses may be unnecessary if no relevant benefit can be derived
from them. A number of these pharmaceutical approaches are quite exorbitant, and the financial
burden can generate added stress to the patients and their families.
In a study conducted among 630 patients in the University of Washington Chronic
Fatigue Clinic, the evaluation revealed that due to their affliction, those suffering from CFS and
fibromyalgia generated several losses, including cars, possessions, jobs, recreational
undertakings, and support of family and friends.8 Since no medical agent has gained the approval
of the FDA as a specific cure to CFS, insurance companies refusing coverage of expenditures on
these medications is an unfortunate likelihood.

Agents prescribed to CFS patients
There is a need to take a closer look at the medications prescribed for the treatment of
CFS symptoms and the mechanisms of their outcomes on the patient’s condition, as they may
generate side effects that can trigger further complications.9
Some of these pharmaceutical agents are emphasized in many medical books and journals
as a guide to patients and clinicians. There are medications that constantly surface in medical
documents concerning CFS while there are others that sporadically appear as antidote to selected
symptoms or to related illnesses, such as fibromyalgia. Others are being subjected to clinical trial
repetitively to ensure that results produce positive stimulus to the body.
Prescribed medications are administered by a physician, who underwent training and
education regarding remedies and scientific solutions to various maladies. It is vital for CFS
patients to see a doctor not only for diagnosis but also, and more importantly, for treatment.
Since some of these medications address only a particular symptom, doctors often combine
different treatment strategies to alleviate patients from various symptoms, making the treatment
more individualized.
Ampligen
Ampligen, or rintatolimod, is a double-stranded ribonucleic acid (RNA) that
contains antiviral and immunomodulatory properties. Ampligen incites the production of
interferon, a protein in the body that helps immune systems adapt to changes in order to
combat infections. Ampligen is a delicate drug given to patients by intravenous means.
Although studies showed that a number of CFS patients experienced improved conditions
after taking Ampligen, there is still the threat of danger to the liver.10

Initially tried in 1987 on individuals with acquired immunodeficiency syndrome
(AIDS), Dr. Daniel Peterson was the first doctor to apply Ampligen on a critical CFS
patient when the physician received FDA approval for its use under this peculiar
condition. Dr. Peterson administered it to more patients with CFS. The findings generated
positive outcomes and registered no toxicity among the patients.
This led to more expanded studies on Ampligen and its effectiveness among CFS
patients. It even came close to obtaining authorization from FDA as the absolute cure to
the syndrome, which still has to be realized. Treatment protocols for Ampligen continue
to evolve because it remains in its trial phase even when it is already in existence for
more than two decades. Physicians are still wary of prescribing Ampligen to persons with
CFS as there are reports that patients experienced fever, dizziness, bowel problems,
weakness, and muscle pains.11
Antibiotics
Antibiotics, which are used to prevent bacterial infections, are given to CFS
patients because many of the symptoms of CFS share similarities with that of an
infectious disease. Certain observations were noted that majority of the CFS patients
being studied started to develop the syndrome from conditions comparable to flu.12 A
clinical analysis was performed that disclosed the evidence of multiple general bacterial
and viral infections in a majority of CFS patients.13 Another study also revealed that a
large margin of CFS patients were positive of mycoplasmal infections. There is an
indication that the extent of infection can be stifled with the use of antibiotics bringing
about steady improvement from numerous clinical signs.14

Hydrophobic tetracyclines, floxacins, clindamycin, erythromycin, Zithromax, and
Biaxin are some of the antibiotics that were found to be effective treatment against
several strains of mycoplasma. There are some antibiotics that are being studied as
possible precautionary medicines against migraine, a common symptom among
individuals afflicted with CFS.15
There are other studies, on the other hand, which suggested that long-term use of
antibiotics can develop strains that make bacteria resistant to the drug.16 Also, there are
the usual side effects disclosed by CFS patients. These are nausea, mental fog, and
gastrointestinal disturbances.17
Anticonvulsants
Anticonvulsants or antiepileptics are primarily prescribed for epilepsy. Lately,
they are recommended to relieve acute and prolonged pain, sleeping disorders, and
anxiety.18 Traditional anticonvulsants, namely Dilantin, Tegretol, and Depakene, appear
to be toxic while newer brands, such as Neurontin, Lamictal, and Topamax, tend to be
safer. Patients have to watch out for dizziness, renal problems, and weight gain, as
possible side effects.19
Antidepressants
Since certain experiments revealed that patients with fibromyalgia, which shares
several similarities with CFS, reacted positively to antidepressants administered in low
doses, physicians also prescribed these drugs to CFS patients. Antidepressants were also
found to help ease pain or ameliorate sleep quality.20 A three-year study that compared
the health of CFS patients who were given antidepressants from those who were not

treated denoted that the former experienced a decline on somatic symptoms in contrast to
the experience of the latter.21
Antidepressants that are tricyclics help in coping with pain as they impinge on
chemicals in the brain. Tricyclic amitriptyline or Elavil, a type of a tricyclic
antidepressant, mitigates several symptoms of CFS, such as sleeping disturbances and
tiredness. If taken in doses lower than that applied to patients with depression, tricyclic
antidepressants appear to be received well by CFS patients. More than the required
dosage may pose threat in the life of patients.22
Some patients also claimed that when given in full, antidepressants aggravate
their fatigue. As doses progress into higher amounts, tricyclic antidepressants may lead to
constipation, drowsiness, and dryness of mouth.23 Antidepressants also increase the heart
rate to a certain extent, reduce sex drive, and cause restlessness. One major consideration
when taking antidepressants are their interaction with other medications, which could
often pose critical effects.24
A clinical trial was conducted in Australia that indicated the lack of substantial
confirmation of antidepressants having benefits on CFS patients. Since depression is a
common symptom among persons with CFS, it is possible that antidepressants were
given mainly to address such condition instead of treating CFS.25 Selective serotonin-reuptake
inhibitors (SSRIs), another type of antidepressant, are recommended for CFS
patients undergoing substantial depression as these drugs work on the neurotransmitters
in the body. Proper guidance is needed when other medications are taken with SSRIs

especially that it is not advisable for them to be taken with tricyclics because such
combination could lead to perilous effects.26
Apart from amitriptyline, other FDA-approved antidepressants that may be
prescribed to CFS patients are fluoxetine HCI, sertraline HCI, mirtazapine, and
citalopram hydrobromide. However, these drugs must never be taken together with
monoamine oxidase inhibitors (MOAIs). Although these medications treat the symptom
of depression, they are not the remedy to CFS.27
Antihistamines
Antihistamines are anti-allergy drugs, which also treat colds and sinus ailments.
CFS patients take antihistamines to remedy allergies and colds as well as to aid them in
their sleeping problems.28 The reason for the latter is that antihistamines can cause
drowsiness. For CFS patients who are experiencing allergies, nonsedating antihistamines,
such as are desloratadine, fexofenadine, and cetirizine, are recommended to be taken
during the day.29 Terfenadine, astemizole, and loratadine are other nonsedating
antihistamines that can also be tried.30
Antivirals
Antivirals address problems of viral infections. Scientists have earlier theorized
that the Epstein-Barr virus and other viruses are possible causes of CFS. Valtrex,
Cytovene, Zovirax, Famvir, Valcyte, Foscarnet, and Vistide are among the antiviral
agents used for treatment.31

The antiviral prescription acyclovir was tested by researchers at the National
Institute of Allergy and Infectious Diseases (NIAID) and the results indicated that CFS
patients experienced improvement when taking acyclovir the same as when they were
taking a placebo, thus, reducing the curative function of the drug in CFS.32
Benzodiazepines
Benzodiazepines are prescribed to CFS patients because of their attributes to ease
muscular pain. They address chronic pains and seizures. Oftentimes, benzodiazepines are
paired with narcotic drugs to help patients with their sleeping problems.33 The
undesirable consequence of taking these types of drugs is that they are addictive. They
may also result to agitation, lightheadedness, and amnesia.34
Gastrointestinal agents
Gastrointestinal drugs are H2 blockers, simple acid reducers, and proton pump
inhibitors. Indigestion or gas, heartburn and acid reflux are the main reasons why CFS
patients take these medications. Minor reasons are to treat ulcer, to remedy gastritis or to
counter a side effect of an NSAID on a troubled stomach condition.35 The survey
conducted in Kansas also reported that CFS patients use gastrointestinal agents to address
certain symptoms of CFS.36
Neurally Mediated Hypotension Medications
Neurally mediated hypotension is an irregularity in the control of blood pressure.
Abnormally low blood pressure and lightheadedness are found to be common symptoms
among CFS patients.

Fludrocortisone, or Florinef, and other pharmaceuticals are often prescribed as
they help the kidney retain salt and water, resulting to enhanced blood levels. A study
conducted in the John Hopkins Hospital, participants with CFS responded positively to
fludrocortisone during a test on the tilt table. 37 Other examples are Pro-Amatine, DHEA,
and vasoconstrictors that help constrict blood vessels and increase blood pressure.
Epogen, based on preliminary studies, intensifies blood volume, which leads to
heightened production of red blood cells.38
Neuroprotective agents and Stimulants
Stimulants and neoruprotective drugs, those that shield neurons from deterioration
or damage, promote alertness and energy to CFS patients. There were experiments
performed that divulged that a number of CFS patients suffer from cognitive inadequacy.
The study among 78 participants used a case-control design, which revealed that
recuperation of upper limb muscle function was a vital indicator of cognitive functioning
among patients with CFS.39
Apart from cognitive functioning, stimulants can also aid CFS patients in
enhancing concentration and memory. Adderall, Dexamphetamine, methylphenidate
(Ritalin) and other drugs that possess Ritalin-like qualities are examples of stimulants.40
Other medications that are stimulants, neuroprotective agents, and cognitive
functioning boosters are acetyl-L-carnitine, dimethylaminoethanol, nicotinamide adenine
dinucleotide (NADH), caffeine, and phosphatidylserine. They increase energy, enhance
cognition, and stimulate alertness. NADH, in particular, activates production of energy in
the body as it generates adenosine triphosphate (ATP), generating strength, endurance,

better energy levels, and lowered depression. Usage of these drugs must be cautiously
considered as results of their effects vary.41
NSAIDs and Pain Relievers
In the Georgia survey, pain relievers, which included Non-steroidal Anti-inflammatory
Drugs (NSAIDs) and narcotic agents, surfaced as some of the treatments
that were mostly taken by CFS patients. Physical pain, arthritis, and headache were the
common reasons for taking such drugs. Ibuprofen, anti-migraine medicines, narcotic pain
relievers, and drugs containing acetaminophen were widely used by the CFS group as
compared to the usage of the other groups in the study.42 Acetaminophen, however, is an
analgesic which can mitigate pain, but not swelling. This is the type of NSAID that do
not severely affect the stomach and is administered to patients with ulcer. The
consequence for taking acetaminophen and other analgesics is that they affect the liver
when taken in high doses.43
Other NSAIDs reduce swelling and pain, as well as fever. A selection of these
pills are either prescribed by physicians or made available over-the-counter. If one type
of NSAID is found ineffectual, patients can try other NSAIDs. Conversely, continued use
of this agent may lead to ulcer and other gastrointestinal problems, as they can cause
damage to the kidneys.44 NSAIDs can also cause stomach bleeding and heart problems.
They must be taken in small doses and with extreme precaution. Skin rashes, dizziness,
headaches, and ringing in the ears, as well as the possibility of depression, are other
probable side effects of these drugs. NSAIDs also diminish blood coagulation; therefore,
cessation of intake prior to surgery is advised.45

Other pharmacological agents
As there is a study that hypothesized the lack of red blood cell magnesium
amongst persons with CFS, magnesium is used as a treatment to enable these patients to
recuperate and improve their welfare. In the clinical test, 32 participants with CFS were
randomly given either placebo or intramuscular magnesium sulphate. Those administered
with magnesium reported that their emotional conditions have improved, their energy
levels were enhanced, and the pains they experienced were reduced. Their red blood cell
magnesium count also reverted to normalcy.46 Magnesium helps produce cellular energy
in the body and provides relief from pain. Forms of magnesium that can be easily
absorbed are magnesium malate, magnesium glycinate, and magnesium lactate. Since
magnesium blood levels sometimes do not manifest if the tissues have been depleted, it
may appear normal, which is a bit misleading. There is the probability that diarrhea or
nausea can take place during intake of magnesium. Once this happens, dosage must be
lowered.47 As such, magnesium therapy is merely recommended only if the magnesium
level of a CFS patient is abnormally low.48
CFS patients are also found to have consumed muscle relaxants. These agents
relieve patients of musculoskeletal-related pains, allowing the muscles to relax and
decreasing muscle contractions. Examples of muscle relaxants are carisoprodol, lioresal,
methocarbamol, and orphenadrine. Muscle relaxants that are nonsedating include
dantrolene, metaxalone, and tizanadine.49
Low dosage of hydrocortisone is also used in treating CFS patients because there
are studies that linked CFS to hypocortisolemia as well as to an imbalance of the

hypothalamic–pituitary adrenal (HPA) axis due to depression, which is believed to
surface through an activation of the HPA axis. Although recipients having CFS exhibited
an improvement after intake of hydrocortisone, there were still reports of mild adverse
reactions caused by this treatment, which include acne and weight gain.50
Sleep medications are also commonly prescribed to persons with CFS to enable
them to fall into sleep, maintain sleep, and awaken well-rested. Amitriptyline or
cyclobenzaprine administered at night in small amounts are advantageous to CFS patients
suffering from sleeping malady. Other medicines which are reported to be beneficial in
having good sleeping conditions are clonazepam, doxepin, and trazodone.51 Further
examples of sleep medications, or sometimes called “hypnotics”, are lorazepam,
alprazolam, oxazepam, quazepam, and triazolam. Some of these agents must be taken in
lesser doses. When taken continuously, these agents often become ineffective in
combatting sleeping disorders. The side effects of a number of sleep medications are
anxiety, restlessness, stomach problems, confusion, nightmares, dizziness, blurred vision,
and morning “hangover.” Patients are advised to consult with a doctor prior to taking
these pharmacological agents.52
Vitamins, minerals, and fatty acids are also administered to CFS patients.
Antioxidants are often taken by patients as a way of lessening the detrimental influence
of free radicals in the body when they trigger the decline of cells, which could produce
several ailments. Some antioxidants are beta-carotene, vitamins C and E, ginkgo biloba,
silymarin, ginseng, bioflavonoids, and proanthocyanidin. Vitamin B12 can help amend
several abnormalities caused by CFS as it enhances stamina and energy, and boosts food
absorption and digestion. As a fat-soluble antioxidant, Vitamin E lowers bad cholesterol

in the body. It preserves tissues and membranes as well as augments glutathione
consumption.53 However, a different study revealed that Vitamin B12, liver extract, and
folic acid were found to be almost the same as the effects of placebo in 15 participants
with CFS.54
Essential fatty acids (EFAs), those that are not produced organically by the body,
have anti-inflammatory and antiviral qualities that provide the body with linoleic acid and
alpha-linoleic acid. When consumed, EFAs moderate the HPA axis, facilitate cytokine
effects, and retain natural membrane structure and control of cell performance.
Testimonials on the use of EFAs disclosed that these agents can address depression,
fatigue, and pain. They may help the immune, digestive, and cardiovascular systems of
the body, support brain performance, and reduce muscular lethargy.55 There are
inconsistent outcomes in trials concerning the treatment of CFS patients with EFAs. One
study showed that a mixture of fish oil and evening primrose oil yielded to positive
results with 85% of participants experiencing better conditions after 15 weeks compared
with those who took placebo. A different trial, on the other hand, revealed no variance
with those administered with fatty acids than with those given with placebo.56
Significance of knowing the side effects of pharmacological drugs
Even though there are journals and literatures detailing the various treatments to
symptoms of CFS, intake of such medications, even over-the-counter pills, must be cleared with
clinicians and specialists. Self-medication is extremely warned as this may aggravate the
patient’s condition. Other physicians often incorporate natural approaches, alternative medicines,

and other therapies to pharmacological approaches, based on how the patient reacts to the
treatment.
Given that there is no standard remedy to CFS, the use of different strategies in treating
patients with this syndrome will need a certain amount of time to determine their result, whether
they enable the body to respond encouragingly or pose further threat to the overall wellbeing of
the patient. A particular pharmacological agent may be able to alleviate one symptom but may
aggravate another. Doctors have to carefully weigh the pros of cons in prescribing a particular
drug to a CFS patient and judiciously monitor its impact on the patient’s condition. It is advised
that treatment must start on low doses to prevent the harmful effects of the drugs. Once the
treatment exhibits unfavorable indication, it must immediately be stopped to avoid further
fatality and be reviewed to resolve its adverse effects.
Unfavorable properties of any pharmacological drug, no matter how small, have to be
taken seriously as they may develop another disorder, worsen other symptoms, or lead to life-threatening
conditions. Advance knowledge of the side effects of the different medications
prescribed to CFS patients is advantageous in the proper management of such drugs, particularly
when multiple treatments are applied. Such knowledge enables patients to better understand the
medicines prescribed to them and immediately report harmful reactions that may surface during
the period of their treatment.
1 David R. McCluskey, “Pharmacological Approaches to the Therapy of Chronic Fatigue Syndrome,” in Symposium
on Chronic Fatigue Syndrome, eds. Gregory R. Bock and Julie Whelan (England: John Wiley & Sons Ltd., 1992), 280.
2 “Drug Development for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome (ME and CFS): Questions and
Answers,” U.S. Food and Drug Administration, accessed July 3, 2014,
http://www.fda.gov/Drugs/NewsEvents/ucm337759.htm.
3 Dawn A. Marcus and Atul Deodhar, Fibromyalgia: A Practical Clinical Guide (New York: Springer Science+Business
Media, 2011), 86.

4 Roumiana S. Boneva, Jin-Mann S. Lin, Elizabeth M. Maloney, James F. Jones and William C. Reeves, “Use of
Medications by People with Chronic Fatigue Syndrome and Healthy Persons: A Population-Based Study of Fatiguing
Illness in Georgia,” Health and Quality of Life Outcomes Journal (2009): 67, accessed July 10, 2014, doi:
10.1186/1477-7525-7-67.
5 James F Jones, Rosane Nisenbaum, and William C Reeves “Medication Use by Persons with Chronic Fatigue
Syndrome: Results of a Randomized Telephone Survey in Wichita, Kansas,” Health Quality Life Outcomes Journal
(2003): 74, accessed July 10, 2014, doi: 10.1186/1477-7525-1-74.
6 Katrina Berne, Chronic Fatigue Syndrome, Fibromyalgia, and Other Invisible Illnesses: The Comprehensive Guide
(Alameda: Hunter House, 2001), 216.
7 Anne-Marie Bagnall, Susanne Hempel, Duncan Chambers, Vickie Orton, and Carol Forbes, The Treatment And
Management Of Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis(ME) In Adults And Children (York:
Centre for Reviews and Dissemination, University of York, 2007), 12.
8 Nassim P. Assefi, Timothy V. Coy, Donald Uslan, Wayne R. Smith, and Dedra Buchwald, “Financial, Occupational,
And Personal Consequences of Disability in Patients with Chronic Fatigue Syndrome and Fibromyalgia Compared to
Other Fatiguing Conditions,” The Journal of Rheumatology Vol. 30 No. 4 (April 2003): 804-804, accessed July 10,
2014, http://www.jrheum.org/content/30/4/804.abstract.
9 “Chronic Fatigue Syndrome,” PubMed Health, accessed July 4, 2014,
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002224/.
10 Susan R. Lisman and Karla Dougherty, Chronic Fatigue Syndrome for Dummies (Indianapolis: Wiley Publishing,
Inc., 2007), 126.
11 Erica F. Verrillo, Chronic Fatigue Syndrome Treatment Guide, 2nd Edition (2012), chapter 4.
12 “Chronic Fatigue Syndrome,” University of Maryland Medical Center, accessed July 8, 2014,
http://umm.edu/health/medical/reports/articles/chronic-fatigue-syndrome.
13 Garth L. Nicolson, Marwan Y. Nasralla, Kenny De Meirleir, Robert Gan, and Joerg Haier, “Evidence for Bacterial
(Mycoplasma, Chlamydia) and Viral (HHV-6) Co-Infections in Chronic Fatigue Syndrome Patients,” Journal of
Chronic Fatigue Syndrome 11:2 (2003): 1.
14 G. L. Nicolson, R. Gan and J. Haier, “Multiple Co-Infections (Mycoplasma, Chlamydia, Human Herpes Virus-6) In
Blood Of Chronic Fatigue Syndrome Patients: Association With Signs And Symptoms,” APMIS 111: 557–66 (2003):
557-558.
(Alameda: Hunter House, 2001), 246 and 252.
20 Barry Leonard, ed., Chronic Fatigue Syndrome: Information for Physicians (Maryland: DIANE Publishing, 1997), 3.
21 Dawn A. Marcus and Atul Deodhar, Fibromyalgia: A Practical Clinical Guide (New York: Springer
Science+Business Media, 2011), 86.
25 Sanne Kreijkamp-Kaspers, Ekua Weba Brenu, Sonya Marshall, Don Staines, and Mieke L Van Driel, “Treating
Chronic Fatigue Syndrome: A Study into the Scientific Evidence for Pharmacological Treatments,” Australian Family
Physician Vol. 40, No. 11 (November 2011): 909.

Inc., 2007), 117-119.
10.1186/1477-7525-7-67.
Inc., 2007), 123.
30 Keiji Fukuda and Nelson M. Gantz, “Management Strategies for Chronic Fatigue Syndrome,” Federal
Practicitioner (July 1995): 24.
33 Sanne Kreijkamp-Kaspers, Ekua Weba Brenu, Sonya Marshall, Don Staines, and Mieke L Van Driel, “Treating
Chronic Fatigue Syndrome: A Study into the Scientific Evidence for Pharmacological Treatments,” Australian Family
Physician Vol. 40, No. 11 (November 2011): 911.
10.1186/1477-7525-7-67.
36 James F Jones, Rosane Nisenbaum, and William C Reeves “Medication Use by Persons with Chronic Fatigue
Syndrome: Results of a Randomized Telephone Survey in Wichita, Kansas,” Health Quality Life Outcomes Journal
(2003): 74, accessed July 10, 2014, doi: 10.1186/1477-7525-1-74.
39 K. Ickmans, M. Meeus, M. De Kooning, L. Lambrecht, N. Pattyn, and J. Nijs, “Can Recovery Of Peripheral Muscle
Function Predict Cognitive Task Performance In Chronic Fatigue Syndrome With And Without Fibromyalgia?”
PubMed Health (April 2014): 511-22, accessed July 10, 2014, doi: 10.2522/ptj.20130367.
(Alameda: Hunter House, 2001), 234-237.
10.1186/1477-7525-7-67.
Inc., 2007), 116.
46 I.M. Cox, M.J. Campbell, and D. Dowson, “Red Blood Cell Magnesium and Chronic Fatigue Syndrome,” The Lancet
Journal Volume 337, Issue 8744 (March 1991): 757, accessed July 11, 2014, doi: 10.1016/0140-6736(91)91371-Z.

50 Robin McKenzie, Ann O'Fallon, Janet Dale, Mark Demitrack, Geetika Sharma, Maria Deloria, Diego Garcia-
Borreguero, William Blackwelder, and Stephen E. Straus, “Low-Dose Hydrocortisone for Treatment of Chronic
Fatigue Syndrome,” The Journal of the American Medical Association Vol. 280 No. 12 (September 1998): 1061-
1066, accessed July 11, 2014, doi: 10.1001/jama.280.12.1061.
(Alameda: Hunter House, 2001), 230-231.
Bibliography:
Berne, Katrina. Chronic Fatigue Syndrome, Fibromyalgia, and Other Invisible Illnesses: The
Comprehensive Guide. Alameda: Hunter House, 2001.
Fukuda, Keiji and Nelson M. Gantz. “Management Strategies for Chronic Fatigue Syndrome,”
Federal Practicitioner (July 1995): 23-24.
Kreijkamp-Kaspers, Sanne, Ekua Weba Brenu, Sonya Marshall, Don Staines, and Mieke L Van
Driel. “Treating Chronic Fatigue Syndrome: A Study into the Scientific Evidence for
Pharmacological Treatments.” Australian Family Physician Vol. 40, No. 11 (November
2011): 909-911.
Lisman, Susan R. and Karla Dougherty. Chronic Fatigue Syndrome for Dummies. Indianapolis:
Wiley Publishing, Inc., 2007.
University of Maryland Medical Center. “Chronic Fatigue Syndrome.” Accessed July 8, 2014.
Verrillo, Erica F., Chronic Fatigue Syndrome Treatment Guide, 2nd Edition. 2012.

Article 14-CFS

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (19)

Similar to Article 14-CFS

Similar to Article 14-CFS (20)

Recently uploaded

Recently uploaded (20)

Article 14-CFS