I received the CAA newsletter today "March-ing On." In it you will find a recommendation for an article on pacing: I was only able to skim it, but what I saw raised grave concerns that the CAA is recommending this. At the beginning it seems that they are disagreeing in part with NICE and GET. But then throughout the text and the charts of 'recovery stages' they say that recovery is normal and pacing, and attitude, are what facilitate this normal recovery. Here are the 3 things that jumped out at me: a) Misery Stage Many ME/CFS symptoms are experienced pain, physical fatigue, poor sleep, head symptoms, digestive symptoms, flu symptoms, etc. Energy production is happening but can damage the body because the body is stuck in a state of stress excess free radical damage is occurring (producing symptoms). If healing, rest and nutrients are not supplied; body goes into adaption phase trading function for existence/self protection. All of the systems from the crash stage may be involved and at differing stages of recovery. Immune system may have become chronically out of balance allowing chronic low-grade infections. Patients have often not fully accepted their illness, they may be resisting, denying and feel very angry and frustrated with the illness. They can also lack understanding about what may be required for recovery. Patients are most at risk of not pacing properly but it is a time where learning how to pace becomes critical in order not to return back to chronic crash stages by over-doing it. b) Reintegration Phase How Chronic Fatigue Syndrome patients recover: the long-term trend is upwards, with natural dips along the way The diagram on the next page demonstrates how patients generally recover from a chronic illness like chronic fatigue syndrome or ME. Part of the process of recovery is to have blips, which are not to be feared or blown out of proportion. Blips DO happen on the road to recovery, and over time they happen less frequently, are less deep and last for a shorter period of time but they DO happen. Graph of the Recovery Process from CFS/ME c) After treating thousands of chronic fatigue and ME patients for six years intensely at the clinic, we have discovered that pacing, or rather lack of pacing can be one of most significant reasons many patients have a slow or delayed recovery.