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Long covid has resurfaced tensions over treatment of chronic fatigue syndrome

Many long covid patients are experiencing extreme fatigue, a situation which has reignited the polarisation in approaches to treatment and rehabilitation of chronic fatigue syndrome (CFS), according to a special report today.

The BMJ reports on examples where doctors have been challenged for speaking out in the media after talking about the role of exercise in rehabilitation.

But it also finds that beyond the controversy, some clinicians see an opportunity for long covid to progress the understanding of post viral syndromes and to acknowledge they are a very real condition.

CFS, also known as ME (myalgic encephalomyelitis), is a complex long-term illness often triggered by an acute infection with a wide range of symptoms that can have a significant effect on daily activities, the most common being extreme fatigue.

In 2011, the PACE trial found that both cognitive behavioural therapy (CBT) and graded exercise therapy (GET) led to greater improvements in some participants than medical care alone. But the results led to controversy as some CFS/ME advocates object to suggestions that their illness has a psychological element.

And tensions have now resurfaced with the advent of the pandemic and long covid.

Around 376,000 people in the UK report symptoms more than a year after covid-19 including extreme fatigue and other symptoms similar to post-viral fatigue syndromes and ME/CFS.

Freelance journalist Melanie Newman spoke to clinicians and academics involved in ME/CFS and long covid research, and found that what advice is given, what research is conducted, and how it is communicated has become a highly sensitive issue.

Some have been challenged for speaking out. For example, Michael Sharpe, a professor of psychological medicine, was castigated for suggesting the disease is “all in the mind” or created by the media, while an activist asked for Trish Greenhalgh, professor of primary care at Oxford University, to be removed from a conference because she had previously commented on exercise and PACE in a public webinar.

Professor Paul Garner at the Liverpool School of Tropical Medicine, who had recovered from long covid, says some advocates actively oppose research on exercise. “They believe the disease lasts for life,” he says. “They reject any research that examines psychological approaches to treatment or that evaluates the role of progressive physical activity in recovery in ME/CFS, and I would assume by extension to long covid.”

Charles Shepherd, medical advisor at the ME Association told the BMJ: “We are not against exercise. Our view is that graded exercise can be harmful.”

Ben Marsh, an NHS consultant paediatrician who contracted viral pericarditis in 2017, thinks physical therapy should be treated like medication or surgery, with patients told about possible side effects and what to look out for.

Newman spoke to other doctors and healthcare professionals helping long covid patients and found them to be very aware of these concerns and quietly working out how best to treat each patient without causing them harm.

Results are – predictably, given the early stage of the research – mixed, she writes, but CFS/ME specialist Rachael Rogers at the Oxford long Covid clinic, says the key is careful screening, assessment and individualised treatments.

Respiratory consultant Paul Whitaker, who set up the first long covid clinic in Yorkshire, says: “For my longstanding patients with long covid who fulfil the criteria for CFS they do seem to get worse with strenuous aerobic exercise. However, long covid is a very diverse group and there are many others who do need an exercise based regimen.” Defining which groups will benefit from exercise remains a challenge, he adds.

In a linked commentary, Carolyn Chew-Graham, GP and professor of general practice research and colleagues argue that patients with long covid are still struggling to get their voices heard above doctors. They believe that this is a form of “structural iatrogenesis,” where patients are harmed by power imbalances in the bureaucratic and cultural systems within medicine.

People with long covid describe feeling “gaslighted” because the opinions of a few have tended to dominate the evolution of treatment, investigation, and a growing knowledge base, they write.

Notes for editors
Feature: Chronic fatigue syndrome and long covid: moving beyond the controversy
Patient Commentary: How power imbalances in the narratives, research, and publications around long covid can harm patients
Journal: The BMJ

Link to Academy of Medical Sciences press release labelling system: https://press.psprings. co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (feature), No (patient commentary)
Evidence type: Feature; Opinion
Subjects: Chronic fatigue syndrome and long covid patients

Marijuana for Chronic Fatigue Syndrome (CFS)

Chronic Fatigue Syndrome (CFS), less-commonly known as myalgic encephalomyelitis (ME), is a medical condition with a variety of debilitating symptoms. The most common symptom is extreme fatigue, a problem which is difficult to manage and can have a major impact on the sufferer’s quality of life.

With a lack of effective conventional treatment options available, more and more people with CFS are now turning to medical marijuana for help. But is cannabis good for chronic fatigue or is this just a fad?

Keep reading to find out more about cannabis for chronic fatigue syndrome, plus some of the best cannabis strains for CFS that are available from your local dispensary.

What is Chronic Fatigue Syndrome?

CFS is a long-term health condition with no known cure. The exact cause of CFS is still unclear, although it is thought to be triggered by several different factors including:

  • A viral or bacterial infection
  • A problem with the immune system
  • Hormonal imbalance
  • Emotional trauma or extreme stress

It also seems likely that there is a genetic factor as CFS appears to run in families to some extent. CFS is more likely to affect women than men, and it usually develops between the mid-twenties and mid-forties.

Chronic Fatigue Syndrome Symptoms

CFS has a variety of symptoms which can get better or worse on a daily basis. People with CFS may suffer from relapses or ‘setbacks’ where their symptoms become significantly worse for some time.

The most common symptoms of CFS include:

  • Overwhelming physical or mental tiredness
  • Muscle and joint pain
  • Headaches
  • Poor memory or difficulty concentrating
  • Dizziness
  • Nausea
  • Insomnia
  • Sore throat or glands
  • Flu-like symptoms
  • Palpitations

These unpleasant symptoms can range from mild to severe and can vary greatly from person to person. They often become worse following over-exercising or physical or mental exertion.

Chronic Fatigue Syndrome Treatments

Since the exact cause of CFS is a mystery, treatment options for the condition are very limited.

Medication can be used to manage symptoms such as headaches and muscle pain, and some common drugs include painkillers and antidepressants. While these treatments can offer some relief, they do carry the risk of side effects, especially strong analgesics such as opioids.

Talking therapies such as CBT (cognitive behavioral therapy) may also be useful for people with CFS. They can help patients to come to terms with their diagnosis, and assist them in developing coping strategies and staying mentally well.

Another good option is graded exercise therapy or activity management. This involves slowly increasing activity levels over time, allowing CFS patients to build up to milestones such as completing household chores or going shopping without triggering a relapse.

In addition to these treatment options, there are also several lifestyle changes which may help to manage CFS symptoms. These include eating a well-balanced, nutritious diet, maintaining good sleeping habits, and finding an appropriate balance between activity and rest.

Although many people with CFS find supplements and complementary therapies such as acupuncture helpful, there is little scientific evidence that these treatments for CFS work.

With such a lack of viable treatment options, it is little wonder that many CFS patients are now turning to medical marijuana to find some relief.

Medical Cannabis and Chronic Fatigue Syndrome

Since marijuana has been illegal for so many years, there is a lack of research specifically regarding cannabis and chronic fatigue syndrome. However, there is plentiful anecdotal evidence that the herb can provide some relief.

Furthermore, a 2011 study into cannabis for fibromyalgia, a condition with many similar symptoms to CFS, found that after using marijuana, patients experienced improvements in pain and stiffness, relaxation, sleepiness, and perceived general wellbeing. The patients who used cannabis also scored significantly higher for mental health compared with those who did not.

It seems the potential benefits of cannabis for CFS patients are numerous. The herb is well-known for its ability to relieve pain, provide relaxation, aid sleep, and help with various emotional issues such as anxiety and depression. But can cannabis relieve the extreme tiredness that makes CFS such a debilitating condition?

The answer is not straightforward, unfortunately, and will depend a lot on the strain of cannabis that you choose. Indica strains are generally associated with relaxation and pain relief but may cause unwanted side effects such as increased tiredness if used during the day. Sativa strains, conversely, are associated with more uplifting, cerebral effects and may help improve energy and mental focus as well as offering relief from depression.

Therefore, if you are looking for a cannabis strain to help you sleep better at night, a potent indica such as the legendary Northern Lights is a good choice. However, if you are suffering from fatigue, a more sativa-leaning strain may be more appropriate.

The Best Cannabis Strains for Chronic Fatigue Syndrome

Most of the cannabis strains that you encounter these days are hybrids, with a mix of indica and sativa heritage. Although pure sativa strains can be hard to find, there are plenty of sativa-dominant hybrids that could offer a burst of energy and potentially provide some relief from CFS symptoms.

Here are some of our favorite cannabis strains for CFS:

Jack Herer

Jack Herer is a classic strain which is known for its powerful high and energizing effects. With a THC content of 18–24%, this sativa-leaning hybrid is often used to treat fatigue as well as mental health issues like anxiety and depression.

Super Silver Haze

Another sativa-dominant strain (70%), Super Silver Haze is a great medicinal strain containing 18–23% THC. One of the most sought-after benefits of this strain is to provide a much-needed energy boost and help to relieve fatigue.

Green Crack

As the name suggests, Green Crack is another powerfully energizing strain. With a THC content of 15–20%, Green Crack is also often used to relieve stress, anxiety, and depression.

Durban Poison

Durban Poison is a landrace cannabis strain from South Africa, meaning that it is as close to a pure sativa strain as you will find these days. With a generous THC content of 17–26%, Durban Poison should improve your physical and mental energy and help you to power through the day.

Sour Diesel

Sour Diesel is a popular strain which has been used for breeding a variety of others with similarly energizing effects. It is 90% sativa-dominant and has a THC content of 18–26%, making it useful in the treatment of fatigue, depression, stress, and pain.

Jet Fuel

Just the name Jet Fuel says a lot about this strain’s potent, energizing effects. This 70% sativa-dominant hybrid is a descendant of Sour Diesel and contains 17–24% THC. As well as relieving fatigue, this cannabis strain may also be useful for those suffering from headaches and depression.

Blue Dream

No list of medicinal strains would be complete without mentioning the ever-popular Blue Dream. This 60% sativa-dominant strain can contain as much as 25% THC, and as well as relieving fatigue, it may also be useful in the treatment of stress and pain.

Although these cannabis strains for CFS are not yet scientifically proven to work, with so few treatment options available, they could well be worth a try.

Using Cannabis for Chronic Fatigue Syndrome

While many people choose to smoke or vaporize their marijuana, there are plenty of other options available too. Although smoking and vaping offer the fastest relief, the effects of edibles may last longer due to the way that cannabinoids are metabolized after oral ingestion.

If you do decide to take the edibles route, you should be cautious as they may take one or two hours to take effect. On some occasions, this has led people to think that their marijuana-infused treats are ineffective and take a second dose, leading to them having a very bad time once they do kick in.

Other options include cannabis oils and tinctures which can be held under the tongue before swallowing. This means that the cannabinoids enter the bloodstream more quickly than they would with edibles, but not rapidly as smoking or vaping.

If you do decide to vape your cannabis for CFS, be sure to set your vaporizer to the right temperature to ensure that you benefit from the full range of cannabinoids and therapeutic terpenes.

And last but not least, a quick word of caution. If you do feel a sudden increase in energy after using cannabis for CFS, don’t be tempted to overdo it. You may feel like you can conquer the world for a few hours, but after the effects have worn off, you could end up feeling a whole lot worse.

Cannabis for Chronic Fatigue Syndrome: Final Thoughts

CFS is a condition which is both difficult to live with and challenging to treat. Although using marijuana for CFS may provide some relief, there is a lack of research into the subject, and it may work better for some people than others.

Here at WayofLeaf, we believe in the healing powers of cannabis, but we are not doctors. If you plan to use medical marijuana for CFS or any other condition, consult a qualified physician for further advice.