Letter: Fatigue research needed- Irish Medical Times


Tate Mitchell posted this to co-cure Mar 19 2010

[if: Another great letter from tomk.]

'Fatigue research needed'

Posted in Letters on 18 March 2010

Dear Editor,
You recently highlighted some comments on chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) from a BMJ editorial (Defeatism undermines treatment of chronic fatigue syndrome, IMT 26/2/10).

Santhouse et al claim cognitive behavioural therapy (CBT) and graded exercise therapy (GET) "have been shown to work" in CFS. What the literature actually shows is that while such therapies can have an effect, this is not the same thing as "working": a meta-analysis calculated the average Cohen sd effect size across various CBT and GET studies to be 0.48, which would generally be described as a
small-moderate effect size (Malouff, 2008).

A recent review of three Dutch CBT studies found that, while patients reported lowered fatigue, their activity levels did not improve and remained low, calling into question claims that CBT is an effective
rehabilitative strategy (Wiborg, 2010).

Systematic reviews tend to ignore "real world" data. An audit of five Belgian rehabilitation clinics offering CBT and GET found that while improvements were recorded in various subjective outcome measures, there was negligible change in results from the exercise test and the average number of hours in paid employment decreased at the end and at follow-up.

The authors give the impression that nothing can be done if CBT and/or GET are not recommended. However a NIH-funded study in the US (Jason, 2007) found a management programme based on the pacing of activities showed superior results to the arms of the trial involving CBT and GET. High rates of adverse reactions have also been reported with graded exercise programmes (Kindlon and Goudsmit, 2010).

ME/CFS is increasingly recognised as a heterogeneous condition. Hopefully, research will shed more light on the subject.

Tom Kindlon,
Information Officer,
Irish ME/CFS Association