New Treatment Option for Difficult Diseases: Chronic Fatigue Syndrome and Fibromyalgia

Neuroscience_Neurology2.jpgChronic fatigue syndrome and fibromyalgia are two diagnosis that remain difficult discern, both to patients and physicians. Both produce nonspecific symptoms of fatigue and pain, with no clear underlying cause. They are a diagnosis of exclusion, given when all other possibilities have been ruled out.

Many people believe that chronic fatigue and fibromyalgia result from an underlying psychiatric illness, based on the associated of anxiety and depression. Still others think an underlying autoimmune disorder or viral infection may be to blame.

A recent report published by a leading expert in the treatment of chronic fatigue syndrome states that an underlying endocrine disorder may be partly to blame. Based on a literature review of more than 50 published studies, it was determined that the majority of patients with these disorders have a dysfunctional hypothalamic-pituitary-adrenal (HPA) system. The HPA system is a complex pathway involving hormones released from the brain that promote the production of cortisol by the adrenal glands. Cortisol has a huge range of effects on a variety of body systems, including metabolism, inflammation and mental function.

The review supported the theory that problems with the hypothalamic or pituitary gland, both located in the brain, result in decreased production of cortisol by the adrenal glands. More importantly, treatment with a low dose oral cortisol medication resulted in improvement in the majority of patients. A further study found 94% of patients to show improvement by their fourth office visit, with the majority reporting a doubling in their energy level and sense of well-being.

There is currently no good treatment for chronic fatigue syndrome or fibromyalgia. A variety of approaches, including pain medication, anti-anxiety medication and counseling may be attempted. Still, the majority of patients are left with significant fatigue and pain that prevent normal daily activities. Administration of low-dose oral cortisol is advocated by some to be a low risk and potentially useful tool in the treatment of these complex and poorly understood conditions.


Holtorf, K. (2008). Diagnosis and Treatment of Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM). Journal of Chronic Fatigue Syndrome, 14(3), 59-88. DOI: 10.1300/J092v14n03_06

  • Joe

    Too much calcium can cause fibromyalgia. It deposits in the muscles. And hypnosis can clear up fibromyalgia, if is is no a B vitamin deficiency, or if there no isn’t excess calcium in the muscles.

  • J Hague

    Low dose cortisol treatment is not a new treatment alternative for this disease. It’s been tried and used for more than 10 years, maybe 15 or 20. Even though short term results are sometimes promising, long term results are abysmal, using oral low dose cortisol. The patient essentially crashes after some point, unless they do what all the untreated patients of this disease do …Drastically modify lifestyle to very low stress levels at all times, and staying that way for life. Cortisol or no. There’s no cure. Some drugs can ameliorate the effects of the disease, but it still limits greatly the amount of responsibility, achievement, and stress the individual can tolerate, for the rest of life.

    Plenty of research and reports have been done on the low dose cortisol phenomena, of improving and then worsening the condition. For quality information on new treatments for CFS (aka CFIDS), go to website or the CFIDS or CFS websites for more current reports on treatment developments, and the more in depth reporting on the use of low dose cortisol over the long term. GNIF Brain Blogger, you are sooooooooo behind the “News” in reporting this new treatment. Try again, with better information. Set the people straight. Don’t mislead them.

  • Trixie M.

    I agree with Hague, lifestyle change is the best option. Plus, once you start on the cycle of taking medications for symptoms, as there is no cure for CFS or fibromyalgia, you cloud everything and the chances of finding the “real” problem (auto-immune disease or other) is more complicated.
    Go back to basics, diet, exercise, and supplements (if your doctor says okay). That is what theDiet Supplement Information Bureau recommends. Then you can get your own body at its best before tinkering with it!

  • Bagass

    Late to the party, but gotta add some important facts to this: All of the evidence we have about altered HPA axis in CFS strongly suggests that a) it does not occur in a large fraction of patients, b) it does not occur at onset, or for some time afterwards, and c) it is only really patients with a history of early life stressors who show signs of altered HPA axis.

    These, plus other bits and pieces, say clearly to me that any HPA abnormalities are probably secondary, and just reflect how stressful and distressing and costly to the patient this disorder is. Probably the only really consistent and virtually universal fact we have about CFS patients is that all the studies show they have among the lowest quality of life for any recognised disorder, including many fatal disorders prior to their final phase.

    I would also add that their is currently no treatment options that produce a unambiguous good result. These patients are clearly very sick, and we do not have any good explanation or therapy to offer them.

  • Pingback: The Personality of Chronic Fatigue | Brain Blogger()

Lindsey Kay, MD

Lindsey Kay, MD, is a medical doctor with training in pathology, and an avid writer. During his training, he worked on pre-clinical and clinical trials in a variety of laboratories related to alcohol effects on the brain, cancer diagnosis, and alternative medicine.

See All Posts By The Author

Do not miss out ever again. Subscribe to get our newsletter delivered to your inbox a few times a month.