Penatalaksanaan Chronic Fatigue Syndrome

Oleh :

dr. Irwan Supriyanto PhD SpKJ

Belum ada penatalaksanaan standar dan kuratif untuk chronic fatigue syndrome (CFS) atau ensefalomielitis myalgik. Penatalaksanaan CFS harus fokus pada terapi suportif dalam mengobati gejala umum dan kondisi komorbiditas, seperti gangguan tidur, nyeri, depresi dan kecemasan, kesulitan memori dan konsentrasi, serta pusing dan kepala terasa ringan.. Penatalaksanaan CFS bersifat simtomatik dengan menggunakan kombinasi terapi farmakologi dan nonfarmakologi.

Berdasarkan kriteria diagnosis terbaru, maka penatalaksanaan chronic fatigue syndrome (CFS) dengan cognitive behavioral therapy (CBT) dan graded exercise therapy (GET) tidak lagi menjadi modalitas utama. Karena dua terapi ini tidak bisa mengatasi post exertional malaise (PEM).[1,10]

Pendekatan Manajemen Gejala, dan Komorbiditas

Referensi

1. Bateman L, Bested AC, Bonilla HF, Chheda BV, Chu L, Curtin JM, et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management. Mayo Clinic Proceedings 2021;96:2861–78. https://www.mayoclinicproceedings.org/article/S0025-6196(21)00513-9/fulltext
2. Cortes Rivera M, Mastronardi C, Silva-Aldana CT, Arcos-Burgos M, Lidbury BA. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review. Diagnostics (Basel). 2019;9(3):91. Published 2019 Aug 7. doi:10.3390/diagnostics9030091
3. CDC. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). 2022. https://www.cdc.gov/me-cfs/index.html
10. Friedberg F, Sunnquist M, Nacul L. Rethinking the Standard of Care for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. J GEN INTERN MED 2020;35:906–9.
11. Vallings R. Guest Editorial: Chronic fatigue syndrome. J Prim Health Care 2019;11:295. https://www.publish.csiro.au/hc/pdf/HCv11n4_ED2
12. Gotaas ME, Stiles TC, Bjørngaard JH, Borchgrevink PC, Fors EA. Cognitive Behavioral Therapy Improves Physical Function and Fatigue in Mild and Moderate Chronic Fatigue Syndrome: A Consecutive Randomized Controlled Trial of Standard and Short Interventions. Front. Psychiatry 2021;12:580924.
13. Castro-Marrero J, Sáez-Francàs N, Santillo D, Alegre J. Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome. Br J Pharmacol. 2017 Mar;174(5):345-369. doi: 10.1111/bph.13702.
14. Gluckman SJ. Treatment of myalgic encephalomyelitis/chronic fatigue syndrome. Uptodate. 2021.
15. Hickie I, Davenport T, Wakefield D, Vollmer-Conna U, Cameron B, Vernon SD, Reeves WC, Lloyd A, Dubbo Infection Outcomes Study Group. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ. 2006;333(7568):575. Epub 2006 Sep 1.
16. Rowe PC, Calkins H, DeBusk K, et al. Fludrocortisone acetate to treat neurally mediated hypotension in chronic fatigue syndrome: a randomized controlled trial. JAMA 2001; 285:52.
17. Blockmans D, Persoons P, Van Houdenhove B, et al. Combination therapy with hydrocortisone and fludrocortisone does not improve symptoms in chronic fatigue syndrome: a randomized, placebo-controlled, double-blind, crossover study. Am J Med 2003; 114:736.
18. Cleare AJ, Reid S, Chalder T, Hotopf M, Wessely S. Chronic fatigue syndrome. BMJ Clin Evid. 2015 Sep 28;2015:1101. PMID: 26415100; PMCID: PMC4585442.
19. FlugeØ, Rekeland IG, Lien K, Thürmer H, Borchgrevink PC, Schäfer C, Sørland K, Aßmus J, Ktoridou-Valen I, Herder I, Gotaas ME, KvammenØ, Baranowska KA, Bohnen LMLJ, Martinsen SS, Lonar AE, Solvang AH, Gya AES, Bruland O, Risa K, Alme K, Dahl O, Mella O. B-Lymphocyte Depletion in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Ann Intern Med. 2019;170(9):585. Epub 2019 Apr 2.
20. Whiting P, Bagnall AM, Sowden AJ, Cornell JE, Mulrow CD, Ramírez G. Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. JAMA. 2001;286(11):1360.

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