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Even though there is so far no cure for either CFS or fibromyalgia, there are many ways to alleviate the symptoms of the two conditions. While treatments don't heal either CFS or FM, they can reduce the effects of symptoms and improve quality of life.

The next four chapters describe the major treatment options for the most prominent symptoms of CFS and fibromyalgia: pain, fatigue, poor sleep and cognitive problems. This chapter outlines an overall approach to symptom management.

The following four chapters discuss the four main symptoms, beginning with sleep. We start with sleep because poor sleep has such widespread effects and because treating it can improve quality of life and reduce other symptoms.

Before doing that, however, let me add that even though we will focus on four symptoms, people with CFS or FM usually experience several or even many additional symptoms. Other common symptoms in CFS and fibromyalgia include:  

• Abdominal pain (bloating, diarrhea/constipation)
• Alcohol intolerance
• Allergies & rashes
• Anxiety
• Chills or night sweats
• Depression
• Dizziness
• Fever
• Headaches
• Jaw pain
• Loss of libido
• Lymph node tenderness
• Nausea
• Numbness or tingling in hands, arms, legs, feet or face
• Ringing in the ears
• Sensitivity to light, sound, smell or weather
• Sore throat
• Weight gain or loss

It also bears repeating that people with CFS and FM often have additional medical problems, so some of your symptoms may be due to other conditions, such as those mentioned in Chapter 2.

Treatment Principles

Managing the symptoms of CFS and FM usually involves the following four principles:

1. Focus on Improving Quality of Life: Because so far there is no cure for either CFS or fibromyalgia, the goal of treatment is not healing but rather controlling symptoms and improving quality of life. Medical treatments usually focus on addressing the most bothersome symptoms, such as poor sleep and pain.

Self-help strategies like pacing, exercise and stress reduction can also help you feel better and more in control. While treatments don't heal either CFS or FM, they can reduce pain and discomfort, bring greater stability and lessen suffering. They may also increase functional level.

Treatment of CFS and FM is not limited to addressing symptoms. The two conditions affect many parts of life: people's ability to work, their finances, their relationships, their moods, and their hopes and dreams for the future. Managing them involves much more than just treating symptoms. A self-management plan includes addressing stress and emotions, getting support and recasting relationships, and coming to terms with loss.

2. Use of Multiple Strategies: Because people with CFS and fibromyalgia have several to many symptoms and because each symptom may have more than one cause, treatment plans usually involve multiple strategies. For example, treating pain often involves both the use of medications and lifestyle strategies such as improving sleep, pacing, exercise, relaxation, and the use of heat and cold.

Cognitive problems ("brain fog") are typically addressed with a variety of techniques, such as the use of lists, pacing, doing one thing at a time, keeping an orderly house, doing mental tasks when sharpest, managing stress, and reassuring self-talk.

3. Experimentation: Finding the most helpful combination of treatments often requires experimentation. There is no standard medical treatment for either illness, that is, no medication that is predictably effective. For this reason, symptom control is usually achieved by trial and error.

Experimentation is also useful to find lifestyle adjustments that are effective. For example, you may have to try different exercise programs to find one that helps you without intensifying your symptoms. We call this process of trying different approaches to find what works being your own CFS/FM scientist.

4. Central Place of Lifestyle Change: The things you do and the way you live have a big effect on your symptoms, reducing them if you honor your body's needs or intensifying them if you don't. These impacts are so great that your success in reducing symptoms and regaining control of your life will probably depend more upon your efforts and willingness to adapt to CFS and/or FM than on anything a doctor does for you.

In the words of CFS/FM physician Dr. Charles Lapp, "While your doctor's role is important, you should recognize that there is no known cure for CFS/ME, so there are limits to what your doctor can do." The key to recovery is "acceptance of the illness and adaptation to it by means of lifestyle changes, for which medical treatment is no substitute."

The major symptoms of CFS and FM have several causes in common: overexertion, deconditioning, stress and emotions. Treating these causes with pacing, exercise, relaxation and managing emotions has a multiplied effect, since each strategy affects more than one symptom.