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  • Chronic Fatigue Syndrome pathway

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    What is Chronic Fatigue Syndrome? 

    Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME/CFS), is a serious and complex chronic condition that causes profound fatigue and a wide range of other debilitating symptoms.

    • Extreme Fatigue: People with ME/CFS experience severe and persistent fatigue that doesn’t improve with rest or sleep. This fatigue is often overwhelming and makes it difficult to carry out even basic daily activities.
    • Post-Exertional Malaise (PEM):  A hallmark of ME/CFS is a worsening of symptoms after any form of exertion – physical, mental, or emotional. Even minor activities can trigger PEM, which can last for hours, days, or even longer.
    • Other Common Symptoms:People with ME/CFS may also experience:
      • Sleep problems (difficulty falling asleep, staying asleep, unrefreshing sleep)
      • Cognitive problems (difficulty thinking clearly, concentrating, memory issues)
      • Pain (muscle aches, joint pain, headaches)
      • Dizziness or lightheadedness
      • Flu-like symptoms
      • Sore throat
      • Tender lymph nodes
    • Causes

      The exact cause of ME/CFS is still unknown, but researchers believe it may be triggered by a combination of factors, including:

      • Viral Infections: Certain viruses, such as Epstein-Barr virus or cytomegalovirus, have been linked with the development of ME/CFS.
      • Immune System Dysregulation:  There is evidence that the immune systems of people with ME/CFS may not function properly.
      • Genetic Predisposition: You may be more likely to develop ME/CFS if you have a family history of the condition.
      • Other Factors: Stress, trauma, and environmental exposures may also play a role in triggering ME/CFS.

    How can we diagnose it?

    Diagnosis is based on a careful review of symptoms, medical history, and ruling out other conditions that might cause similar symptoms. An Internal Medicine Physician with deep knowledge of systemic disease is best placed to diagnosed it. 

    How can we treat it?

    Discover MIAL multidisciplinary pathway for Chronic Fatigue  Syndrome 

    Dr Luigi De Michele

    Dr Valentina Buscemi 


    Comprehensive and Holistic Internal Medicine Physician Review with Dr Luigi De Michele, relevant diagnostic and physiotherapy programme  with Dr Valentina Buscemi 

    SESSION 1: 

    • The impact of CFS in life• Vicious cycle of pain and fatigue /the boom and bust cycle: psychoeducation• Practice: Present moment awareness, return to the body, to its smaller signals, grounding



    • CFS and stress: mechanisms• Notice the internal experience: reactions/emotions/thoughts/habits/body sensations and their toll on energy levels• Window of tolerance and pacing• Body scan



    • Practice checking-in with yourself and where you are in the here and now• 3 Ps: Planning, prioritizing and pacing: practical strategies • Goal setting and barriers• Mindful movements



    • Defusion techniques (work with the mind)• Relaxation, self-regulation techniques including breathing techniques• Movement practice



    • Values based actions (our inner compass) • Choice point: towards and away moves in daily activities• Goal setting towards moves: to improve physical level (activity chart and/or circuits)



    • Acceptance: Aware, do what matters, open up to difficult experience (etc. thoughts, emotions)• Sleep hygiene• Movement practice


    SESSION 7 

    • Kindness towards the body and the importance of self-care and self-compassion• The emotions pass through the body: the compassionate hand practice• Compassionate actions and movements



    • Communication• Summary of skills learnt• How to keep changes in the long-term