Core Treatment Principles
Start Low, Go Slow
Patients are often medication-sensitive. Begin with lowest doses and titrate slowly.
Treat Symptoms, Not Labels
Target specific symptoms rather than trying to treat the overall condition.
Pacing Before Exercise
Traditional graded exercise therapy (GET) can harm patients. Prioritize pacing and energy management.
Multidisciplinary Approach
Coordinate care between primary care, specialists, and allied health professionals.
Patient-Centered Goals
Focus on what matters to the patient - often function over cure.
Treatments to Avoid
Graded Exercise Therapy (GET)
Can worsen PEM and cause long-term harm. Contraindicated per NICE guidelines.
Try instead: Pacing and energy conservation
High-Intensity Exercise
Post-exertional malaise means exercise pushing causes crashes.
Try instead: Gentle movement within energy envelope
Aggressive Pushing
Encouraging patients to push through symptoms leads to crashes.
Try instead: Listen to body signals
Unproven Cure Protocols
Be skeptical of expensive treatments with limited evidence.
Try instead: Evidence-based symptom management
Symptom Management
Pain Management
Options
- Acetaminophen - first line for mild pain
- NSAIDs - ibuprofen, naproxen (caution with GI/kidney)
- Low-dose naltrexone - emerging option
- Gabapentin/pregabalin - neuropathic pain
Clinical Considerations
Avoid opioids - not effective for this condition and risk dependence
Sleep
Options
- Sleep hygiene optimization
- Melatonin - low dose (0.5-3mg)
- Low-dose amitriptyline
- Caution with benzodiazepines - can worsen OI
Clinical Considerations
Unrefreshing sleep is core symptom - focus on sleep quality not just duration
Cognitive Dysfunction
Options
- Stimulants - limited use, not curative
- Cognitive pacing strategies
- Environmental modifications
- Executive function aids
Clinical Considerations
Cognitive rest is as important as physical rest
Monitoring and Follow-up
Initial Assessment
- Complete history and physical
- Orthostatic vital signs
- Baseline labs
- Quality of life assessment
1-3 Months
- Symptom tracking
- Medication tolerance
- Functional status
- Adverse effects
3-6 Months
- Review treatment response
- Adjust management plan
- Consider referrals
- Update documentation
Ongoing
- Regular symptom review
- Quality of life monitoring
- Comorbidity management
- Advance care planning if severe
Apply This Knowledge
Use our interactive tools to practice treatment planning and patient management.