Fatigue

Going to see someone who can help you work out a proper plan for managing fatigue can be very helpful. Picking bits of advice from magazines and online is not usually very useful.

A lot depends on the skill and sympathies of the practitioner and how you feel about working with them. Complementary therapies are not widely available through the NHS, so a typical session could cost you from £40 to £80. 

You should always look for a practitioner who is properly trained and registered with the relevant professional body.

Summary
Acupuncture is a traditional form of treatment that began in China thousands of years ago. Thin needles are inserted into the skin at special points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.

Evidence
Research from China suggests that acupuncture can be helpful but most studies are not conclusive. In China other treatments, such as herbs, are often given alongside acupuncture.

Safety
Acupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally).

Cost
A session may cost £40-£60. Frequency of treatment will depend on you and your practitioner.

Find out more
The following professional organisations can help you find a qualified practitioner:
Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society

Summary
Herbs have been the core part of traditional Asian systems of medicine and are still very widely used today. In the major systems, of traditional Chinese medicine and Ayurvedic medicine in India, as well as others like Unani from south Asia, Kampo from Japan as well as variations in Korea, Tibet, Vietnam and elsewhere, there was an energetic approach to understanding the body’s ailments. Fatigue was generally seen as a deficiency in energies from various functions in the body and different tonic approaches were selected according to what these were. This meant that traditional appraches to fatigue were usually very individual and complex.

Evidence
Because of the individualised approach of traditional Asian systems it has been very hard to get generalised evidence of effectiveness in the research literature. However many millions of people have used these approaches and they remain popular.

Safety
If you decide to try Chinese or Indian herbal medicine for fatigue, it is important that you consult a member of one of the organisations mentioned below to ensure that the remedies you are prescribed are of good quality and that you get appropriately tailored care.

Cost
Visiting a qualified practitioner may cost between £60-80 for a first session though further visits and the cost of the treatment will be less than this.

Further information
The European Herbal and Traditional Practitioners Association is the umbrella body for herbal medicine in the UK. Make sure you see a practitioner who belongs to one of their member organisations.

Summary
Graded exercise therapy (GET) uses regular, slowly increasing physical activity (in its broadest sense) to encourage recovery from CFS. You and your physiotherapist can design an effective GET programme together. This programme will take into account your current levels of activity and other important features, such as sleep and the usual ups and downs of CFS. There is encouraging evidence that some patients may benefit from GET. However, some patients may prefer other management approaches such as rest or pacing.

Evidence
Graded exercise therapy (GET) is recommended in the NICE guidelines for CFS. But some patients find this treatment less acceptable than other approaches. In surveys, some people said they found GET helpful, while others said it made them feel worse.

Safety
It is important to start at a level that is suitable for you, even if this is very low. GET programmes must be supervised by a specially trained physiotherapist. If you have not exercised for many months, you will inevitably feel achy once you start again. If your GET is being properly supervised, hurt shouldn’t mean harm. Proceed with care and if it hurts a lot, stop and get advice.

Cost
There is no cost if you get this type of help through the NHS.

Further information
Your GP should be able to refer you to a specialist NHS team who work with CFS patients.
It is important to find a qualified physiotherapist to supervise your programme. Ask your GP to recommend one.

Summary
The basic principle of homeopathy is that like cures like. Homeopaths use tiny amounts of medicine, which are supposed to nudge the body’s self-healing processes into action. Homeopathy has been called ‘unscientific’ because homeopathic remedies are sometimes diluted (watered down) so many times that no detectable trace of medicine remains. Homeopaths respond that they capture some useful non-material trace of the original material.

Evidence
Two studies have looked at whether homeopathic treatment helps people with chronic fatigue. One of the studies was well designed, both reported some improvements.

Safety
Homeopathic medicines prescribed by trained professionals are safe. Some patients complain of mild worsening of their symptoms but this generally only lasts a short time. There is potential risk that an enthusiastic pursuit of such a radically different approach can mean that the need for other treatments may be ignored.

Cost
The monthly cost will depend on how regularly you receive treatment. A session with a qualified homeopath varies from £25-£60.

Further information
There are a number of professional organisations covering homeopathy:
The British Homeopathic Association
Faculty of Homeopathy
The Society of Homeopaths

Summary
There are many different types of massage, some more vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils.

Evidence
One very small trial showed that massage therapy helped with fatigue, pain, sleep problems and low mood.

Safety
Massage is safe if carried out by qualified massage therapists, and it rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage.

Cost
Monthly cost will depend on how regularly you receive treatments.

Further information
It is important to find a qualified practitioner such as one registered with The General Council for Soft Tissue Therapies.

Summary
Osteopathy is an established hands-on diagnosis and treatment method, whose main emphasis is on the way the muscles and joints work. It recognises that pain and disability often stem from physical strains and tensions in the body, rather than from damage caused by disease. Osteopathy focuses on whole body health by treating and strengthening the musculoskeletal framework. This includes the joints, muscles and spine. The aim is to positively affect the body’s nervous, circulatory and lymphatic systems.

Evidence
One study showed that osteopathy might help some people with symptoms in chronic fatigue but more studies are needed before we can be more certain.

Safety
Side effects are rare and mainly linked to manipulation of the neck. Some mild after-effects from treatment can happen (aches) but they usually last less than 48 hours.

Cost
A session may cost £40-£60. Frequency of treatment will depend on you and your practitioner.

Further information
Osteopathy is a state-regulated profession and all chiropractors have to be registered with The General Osteopathic Council.

Summary
Chronic fatigue most often combines a confusing mix of emotional and psychological upsets as well as the physical symptoms. The latter may of course be the cause of the former but most often it is difficult to separate the ‘chicken from the egg’: a holistic approach is often best.

Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says “CBT can help you to change how you think (‘cognitive’) and what you do (‘behavioural’)”. For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

Evidence
A number of good studies have shown that CBT can help ease problems related to chronic fatigue. Many people (not all though) felt less fatigued after a course of CBT.

Safety
CBT techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.

Cost
In most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions

Further information
It is important to find a qualified counsellor or psychologist. Contact The British Psychological Society.

Summary
Tai chi is also known as ‘moving meditation’. It is a series of slow, graceful, controlled movements, which develop strength, balance, posture and inner peace. It is a discipline that has to be learned in a class from a teacher and can then be practised at home.

Evidence
Tai chi has been recommended for people with fatigue but no studies have been carried out yet. But there is recent evidence that it can help people with fibromyalgia (FMS), which is a problem that a lot of CFS sufferers also have (see also MUSCLE ACHE).

Safety
Tai chi is safe for most people. Though tai chi is slow and gentle, anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise and build up gently.

Cost
Once you have learned the movements, you can do the exercises at home, at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services. You can also contact the The Tai Chi Union.

Summary
Yoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.

Evidence
One study showed that yoga was helpful but more studies, based on larger samples, are needed to be certain of this.

Safety
Yoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.

Cost
You will have to pay for the classes but once you have learned this technique you can practise it at home at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services. To find a qualified teacher near you see also the The Yoga Alliance
and the The British Wheel of Yoga.