Does anyone know what underpins this recommendation? CFS Toolkit - Treatment and Management Rationale for management Treat other illnesses or conditions occurring at the same time as CFS or underlying medical/psychiatric conditions. Identify the most bothersome symptoms. Employ drug therapy to relieve symptoms. Empower the patient to be active in managing the illness. Drug therapies Use as few medications as possible. Remember that supplements and over-the-counter drugs can interact with prescription drugs and cause side-effects, please consult with a clinician before taking any of these medications. Start with a small dose because many CFS patients are sensitive to medications. Narcotics are not indicated for management of CFS-associated pain. Medicine for pain or discomfort should be limited to acetaminophen, aspirin, or NSAIDS (nonsteroidal anti-inflammatory drugs). Do not routinely use sleep medications to treat sleep problems. Sleep medication should be prescribed based on patient’s responses to a complete sleep history. Treat clinical depression only. People with CFS may show signs of depression, but not have depression. Prescribing drugs for depression when a person is not depressed may make symptoms worse. Use caution in prescribing/taking antidepressants. Some antidepressants may make individual CFS symptoms worse or cause side effects. While use of a multivitamin is generally recommended for people who do not have balanced diets, it is not beneficial to buy trendy, expensive vitamins that have no effect on fatigue or pain. Avoid unsafe herbal remedies like comfrey, ephedra, kava, germander, chaparral, bitter orange, licorice root, and yohimbe. Non-drug therapies Consider complementary therapies like acupuncture, gentle massage, deep breathing, relaxation therapy, yoga, or tai chi to increase energy and decrease pain. Suggest stretching and light exercise before bed. Help patients cope with memory difficulties by suggesting the use of organizers and schedulers. Puzzles, word games, and card games are other options to help increase focus.