Chronic Fatigue Syndrome
Researchers from the Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University in the UK investigated the effectiveness and safety of four treatments for Chronic Fatigue Syndrome: (1) Specialist Medical Care (SMC) alone, or with (2) Adaptive Pacing Therapy (APT), (3) Cognitive Behavioral Therapy (CBT), or (4) Graded Exercize Therapy (GET).
In a parallel-group randomized trial, patients meeting Oxford criteria for chronic fatigue syndrome were recruited from six secondary-care clinics in the UK and randomly allocated by computer-generated sequence to receive one of the four conditions.
Primary outcomes were fatigue (measured by Chalder fatigue questionnaire score) and physical function (measured by short form-36 subscale score) up to 52 weeks after randomization, and safety was assessed primarily by recording all serious adverse events, including reactions to the trial treatments.
Do you remember when AIDS was first discovered? Do you remember the stigma attached to the illness and how that stigma created much more pain and devastation than the physical illness itself (as if it weren't bad enough)? Who can forget, actually? The patients... the disregarded... fought like hell to be recognized and respected, treated and researched. No one ever thought AIDS could be successfully treated or that people could live productive lives after diagnosis.... but how wrong that was!
Investigators from the Chronic Fatigue Center at Radboud University Nijmegen Medical Centre in The Netherlands tested the usefulness of a minimal, cognitive behavioral intervention consisting of guided self-instructions combined with email contact on 171 chronic fatigue patients in a randomized, controlled trial.
Eighty-five were randomized to the intervention condition, and 86 to a wait list control condition. All subjects . met the Centers for Disease Control and Prevention criteria for chronic fatigue syndrome.
Researchers from the University of Sheffield in the UK evaluated the effectiveness of homeopathic treatment for reducing the symptoms of Chronic Fatigue Syndrome.
Using a triple-blind design, 103 patients were randomly assigned to homeopathic medicine or an identical placebo condition. Patients had monthly consultations with a professional homeopath for 6 months. Outcomes were measured on the MFI - Multidimensional Fatigue Inventory. Secondary outcome measures were the Fatigue Impact Scale (FIS) and the Functional Limitations Profile (FLP).
Ninety-two patients completed treatment in the trial (47 homeopathic treatment, 45 placebo). Eighty-six patients returned fully or partially completed posttreatment outcome measures (41 homeopathic treatment group who completed treatment, 2 homeopathic treatment group who did not complete treatment, 38 placebo group who completed treatment, and 5 placebo group who did not complete treatment). Seventeen of 103 patients withdrew from treatment or were lost to follow-up.
Cochrane analysts examined five randomized, controlled trials of the efficacy of exercise therapy for Chronic Fatigue Syndrome (CFS) and found that after 12 weeks, those receiving exercise therapy were less fatigued than the control participants (SMD -0.77, 95% CIs -1.26 to -0.28). Additionally, physical functioning was significantly improved with exercise therapy (SMD -0.64, CIs -0.96 to -0.33) but there were more dropouts with exercise therapy (RR 1.73, CIs 0.92 to 3.24).
Investigators from the Department of Medicine at the University of Washington in Seattle looked at patterns of alternative medicine use among twins where one twin of the pair had CFS and the other did not. They also looked at the perceived helpfulness of these methods, and how often these therapies were discussed with physicians.
We found this report in Karen Richards’ Fibromyalgia Newsletter .
Scientists have discovered that people with chronic fatigue syndrome (CFS) have certain genes and gene activities that reduce their body’s ability to deal with physical and psychological stress.
"It really is the first credible evidence of a biological basis for chronic fatigue syndrome," said Dr. Julie Gerberding, director of the Center for Disease Control (CDC) at a press briefing held to announce the results of the largest-ever clinical trial focusing on chronic fatigue syndrome. The research has been published in a set of 14 articles appearing in the April, 2006 issue of the scientific journal Pharmacogenomics.
The September 19th issue of JAMA/b> features a systematic review of the literature on what interventions have been found to work for chronic fatigue syndrome. Nineteen databases were searched for any published or unpublished studies in any language, and the study included randomized and nonrandomized controlled trials. Of 350 studies, 44 met the inclusion criteria, including 36 randomized controlled trials. In these studies, subjects numbered from 12 to 326, with a total of 2801 participants combined. The most promising results were in cognitive behavioral therapy and graded exercise therapy. However, there were sufficient design inadequacies in many of these studies, to conclude that further investigation is warranted.
Citation: Whiting P, Bagnall AM, Sowden AJ, Cornell JE, Mulrow CD, Ramirez G. Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. JAMA. 2001 September 19; 286(11): 1378-9.
Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study.
Sixty patients with Chronic Fatigue Syndrome from 3 different London hospitals were randomly assigned to either cognitive behavior therapy or a relaxation therapy. Five years later, 53 of them completed questionnaires and interviews measuring their improvement in symptoms. A total of 68% of the patients who received behavior therapy, and 36% who received relaxation therapy rated themselves as much improved at the 5 year follow-up. In addition, significantly more CBT patients met the criteria for complete recovery, freedom from relapse, and steadily improved symptoms, as compared to the relaxation therapy group. The study concludes that cognitive behavior therapy can produce lasting benefits for CFS, but is not a cure.
Citation: Deale, Husain, Chalder & Wessely. Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study. American Journal of Psychiatry 2001 Dec; 158 (12): pp. 2038-42.
Cognitive behaviour therapy appears to be an effective and acceptable treatment for adult out-patients with chronic fatigue syndrome. A systematic review by Price and Couper for the Cochrane Library, Issue 2, 2001, looked at all randomized controlled trials of cognitive-behaviour therapy (CBT) for adults with chronic fatigue syndrome (CFS).
Although only 3 relevant trials of adequate quality were found, these studies managed to demonstrate that CBT significantly benefits physical functioning in adult out-patients with CFS, when compared to orthodox medical management. In addition, these patients found these tools highly acceptable.Cognitive behaviour therapy appears to be an effective and acceptable treatment for adult out-patients with chronic fatigue syndrome. A systematic review by Price and Couper for the Cochrane Library, Issue 2, 2001, looked at all randomized controlled trials of cognitive-behaviour therapy (CBT) for adults with chronic fatigue syndrome (CFS).