Comparison of therapies for chronic fatigue syndrome

January 01, 0001

Comparison of therapies for chronic fatigue syndrome

Trial findings show cognitive behaviour therapy (CBT) and graded exercise therapy (GET) can be effective treatments for chronic fatigue syndrome, but patients' organisations have reported that these treatments can be harmful and favour pacing and specialist health care. The researchers from the UK aimed to assess effectiveness and safety of all four treatments. In their parallel-group randomised 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 specialist medical care (SMC) alone or with adaptive pacing therapy (APT), CBT, or GET. They recruited 641 eligible patients, of whom 160 were assigned to the APT group, 161 to the CBT group, 160 to the GET group, and 160 to the SMC- alone group.

Compared with SMC alone, mean fatigue scores at 52 weeks were 3.4 points lower for CBT and 3.2 points lower for GET, but did not differ for APT. Compared with SMC alone, mean physical function scores were 7·1 points higher for CBT and 9.4 points higher for GET, but did not differ for APT. Compared with APT, CBT and GET were associated with less fatigue and better physical function. Subgroup analysis of 427 participants meeting international criteria for chronic fatigue syndrome and 329 participants meeting London criteria for myalgic encephalomyelitis yielded equivalent results. Serious adverse reactions were recorded in 1% of participants in the APT group, 2% in the CBT group, 1% of 160 in the GET group, and 1% of 160 in the SMC-alone group.

The researchers concluded: "CBT and GET can safely be added to SMC to moderately improve outcomes for chronic fatigue syndrome, but APT is not an effective addition."

Difficult research amidst such vague territory and difficult to externally generalise.

For the full abstract, click here.

The Lancet published online 18 February 2011 © 2011 Elsevier Limited
Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. PD White, KA Goldsmith, AL Johnson et al on behalf of the PACE trial management group. Correspondence to PD White: [email protected]

Category: P. Psychological. Keywords: comparison, adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, specialist medical care, chronic fatigue syndrome, parallel group randomised trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 11 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.