management

Last reviewed 01/2018

Before considering it as part of an illness it is worth checking if it is likely to be physiological. At first consultation consider physical causes.

  • physical examination reassures both doctor and patient
    • patient feel that that their complaints are considered seriously by the doctor
    • doctor may identify organ based illness (1)
  • investigations should be restricted to those that are appropriate
    • abnormal investigation are related to symptoms in less than 10% of patients (2)
  • psychological causes - some doctors fear that probing emotional illness will precipitate emotional distress. It is an opportunity to relieve anxiety and distress
    • in fatigue lasting more than 2-3 months with other symptoms or signs of depression or anxiety, antidepressants such as sertraline 50 mg daily can be tried out (should be discontinued after 4 weeks if there is no improvement) (2)
  • the following clinical features should be explored carefully to determine any serious physical disorder:
    • localizing and/or focal neurological signs
    • signs and symptoms of inflammatory arthritis or connective tissue disease
    • signs and symptoms of cardio-respiratory disease
    • significant weight loss
    • sleep apnoea
    • clinically significant lymphadenopathy (2)

Advice should be given to patients to manage symptoms in order to minimize their impact on daily life (2).

  • regular physical activity e.g. - walking, stretching and aerobic exercise (3)
  • diet
    • regular meals with a well balanced diet which comprises of slow release starchy foods
    • nausea can be managed conservatively (e.g. - eating little and often, snacking on dry starchy foods and sipping fluids) but in severe cases anti emetic drugs can be used (2)
  • sleep management
    • advice on sleep management and sleep hygiene
    • treat any concomitant diseases e.g. - depression, anxiety
  • rest and relaxation
    • explain about the role of rest and short naps which will enhance performance (2,3)
    • relaxation methods may help in managing pain, sleep problems and concomitant stress or depression (2)
  • for patients with depression selective serotonin reuptake inhibitors, such as fluoxetine, paroxetine, or sertraline may be used to increase the energy (3)
  • education and employment
  • advice people about continuing education or work and review regularly (2)

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