Wed, 11 Oct 2006 20:43:41 EDT
Behavioural Therapy Works For Chronic Fatigue Syndrome, Says New Study
A study published in the Journal of the Royal Society of Medicine has found that behavioural interventions such as cognitive behavioural therapy and graded exercise therapy are effective treatments for chronic fatigue syndrome in adults.
The study was commissioned by the National Institute for Health and Clinical Excellence (NICE) as part of a guideline review of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) treatment. The draft NICE guidance has been released for public consultation.
Chronic fatigue syndrome is a debilitating condition characterised by fatigue on minimal exertion. Other symptoms include headaches, sleep disturbance, cognitive difficulties and muscle pain which vary widely between patients.
CFS affects both adults and children and, in the UK, it is estimated that 30 to 40 people in every 10 000 are affected by the condition.
"There is good evidence that cognitive behavioural and exercise therapies reduce symptoms and improve physical function in adult patients with CFS," said Duncan Chambers* one of the study's researchers.
"However, little is known about the most effective treatment of CFS in children and young adults." he said.
Mr Chambers and his colleagues** conducted an exhaustive systematic review of all randomised and non-randomised controlled trials of CFS/ME interventions, concentrating particularly on studies published since 2001. Any trial that included treatment or combinations of treatment for adult and child participants was eligible for inclusion. A total of 70 papers were examined including studies on behavioural, immunological, pharmacological, complementary therapies and nutritional supplements.
"Homeopathy and supplements such as essential fatty acids and magnesium have shown some small beneficial effects in single trials, however, we require further rigorous clinical trials to test their efficacy in the treatment of CFS," said Mr Chambers.
"Immunological and anti-viral treatments may have beneficial effects but are also associated with harmful side-effects. Most pharmacological treatments, for example anti-depressants, have not shown beneficial effects in the treatment of CFS/ME."
Mr Chambers said the last five years had seen a significant increase in the size and quality of the evidence base on interventions for CFS/ME, however, more research was required.
"Further investigation is required to evaluate the effectiveness of interventions for severely affected patients," said Mr Chambers.
"Many studies require patients to attend a clinic for treatment and/or assessment. These conditions may exclude people severely affected with CFS/ME from taking part and perhaps bias the sample towards patients with less severe symptoms.
"Also treatment of children with CFS/ME has developed through consensus rather than evidence. Greater research effort is required to understand the efficacy of treatments for children with CFS/ME," Mr Chambers said.
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* Centre for Reviews and Dissemination, University of York
** University of York and Leeds Metropolitan University
'Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review' by D Chambers, AM Bagnall, S Hempel and C Forbes is published in the October 2006 issue of the Journal of the Royal Society of Medicine.
JRSM is the flagship journal of the Royal Society of Medicine. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.
Founded in 1805, the Royal Society of Medicine is an independent organisation that promotes the exchange of knowledge, information and ideas in medical science and continued improvement in human health.
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