Managing chronic fatigue syndrome (myalgic encephalomyelitis)

You might then decide that walking the dog once a week drops the difficulty level to 30 per cent.

Now you are in profit (10 per cent), so can think about taking it on.

8. Make a recovery plan

Once you've decided what your main aims are going to be, decide how much time you'll give yourself to make progress. At this point you may need to take the advice of family, friends or your doctor because it's likely you'll want to go faster than might be feasible.

If you are only mildly affected (coping with most daily activities/getting to work most days) and are managing financially, why push so hard that you risk upsetting this? On the other hand, if you are housebound, small gains are large percentage improvements, so don't risk creating set backs.

Any progress is good progress, and it's important to take heart from that. Frustration at 'slow' progress is understandable, but is negative and erodes gains you make. Where you may be in the most difficulty is if the CFS/ME persists long enough to cause secondary problems such as with employment. External pressures on you to get better are much less under your control and may increase the stress of being ill.

9. Sort out employment issues

If you are in a job that protects your pay when off sick, it will be financially tolerable to be off work for a while. However, you may worry about the knock-on effects on later promotion. Few employers are as good as the best when it comes to dealing with ill employees. A phased recovery to work should be the norm, but only a minority of employers manage to embrace this idea. Most require you to be fully fit to do a whole day's work or not work at all; in some types of occupation no other option is possible.

If you can, talk to your employer about the possibility of coming back slowly by:

If you need to be off work completely, you will need to be signed off formally by your GP. When that period of disability goes on for months, you will find that the benefits system goes into action. Depending on the outcome of their deliberations, you will either be transferred to invalidity benefit or be told you are fit to work.

Unfortunately, the medical assessors cannot base their 'fitness to work' decision on whether someone is capable of returning to their old job, nor is it their role to provide someone with employment. This can sometimes lead to unjust decisions. The appeal process is lengthy and a common source of unnecessary stress to patients. Now that CFS/ME has been properly embraced by the Department of Health, we might see less of this problem arising.

10. Sort out pain control

Painkillers may help muscle pains; it's best to start with the simple ones such as paracetamol, using them at the correct dose and sufficiently often. Taking painkillers after a pain has come on is fine for occasional symptoms. However, if the pain is regular and you wait until you can't tolerate it before taking the medicine, you won't get full relief.

Mixtures of paracetamol and codeine are slightly more effective, but can cause constipation or nausea. Anti-inflammatory medicines of the ibuprofen family (called NSAIDs or non-steroidal anti-inflammatory drugs) are also worth trying, but may cause indigestion and, rarely, allergic reactions. Aspirin has been noted to be more effective than some other analgesics, but may cause stomach upset.

Many people with CFS/ME note that they get poor pain relief from conventional analgesics; however, there is some evidence that a low dose of a tricyclic antidepressant such as amitriptyline can be an effective painkiller. At low doses you get fewer of these drugs' side effects, such as a dry mouth and constipation. This is particularly important, because many people with CFS/ME are over-sensitive to tricyclic antidepressants. Taking the dose in the evening may also help sleep, which is an important aspect of dealing with CFS/ME.

Acupuncture could be considered as a drug-free alternative, as could TENS (transcutaneous nerve stimulation). With TENS, a tiny electric current is sent through electrodes applied to the skin, which may block pain signals in the spinal cord.

All of these treatments should be guided by your doctor.

11. Look at your illness beliefs and reactions

This is a bit like DIY cognitive behaviour therapy (CBT), but it can be increased in value if you get your partner or friend to work though it with you. The central reasoning in CBT is that our interpretation of a disease's symptoms modifies our reactions to the disease in ways that can amplify or worsen the condition. By tackling these interpretations and steering them in a different direction, we can positively influence our reactions to being unwell.

For example, if you strongly believe that your CFS/ME has a physical cause and you can't see yourself coping until that cause is identified, you will have a significant block to improvement. Here, the illness belief is one of a need to identify cause. The therapeutic response to this belief would run along the lines that you do not need to know the cause of an illness to begin healing from it. By accepting this belief, you remove the block to improvement.

Often the 'two-column technique' is used to list original beliefs down one side and alternative, more helpful thoughts down the other.

List alternative reactions (which is where it is helpful to have a partner) and focus on accepting these over the negative ones. Despite its simplicity, this sort of technique can have a strong impact on the experience of illness.

12. Allow time for relaxation

Although the 'yuppie flu' label that was applied to CFS/ME a few years ago was wrong, there is almost always some value in reassessing the stresses and strains that we put ourselves through on a daily basis. Particularly useful is deliberately making time for relaxation and getting into the frame of mind that sees it as essential to wellbeing, rather than a waste of time.

There are many ways you can unwind: yoga classes, meditation, massage and aromatherapy are popular for good reasons, and they can encourage you to discover the lost art of relaxation. Perhaps you used to have a hobby you enjoyed, or there's a new one that takes your fancy. Rest periods therefore need not be wasted time. Getting into the habit of making time for yourself should be a priority for everyone.

13. Consider complementary treatments

Discuss with your doctor whether a trial of NADH, carnitine, co-enzyme Q10 or one of the other complementary treatments is worthwhile. Some of these are beyond the normal range of treatments that a GP will use or have experience of, so it won't always be possible for the doctor to express an informed opinion about them. Hopefully, most doctors have no objections to agreeing to safe treatments, even if the chance of success is low.