Addressing chronic fatigue: treatments brings long-term benefits

A young boy showing signs of fatigue. (Photo: Pixabay)

A study on chronic fatigue syndrome patients who took part in a trial where they showed significant improvements after 1 year of cognitive behavioral therapy and graded exercise therapy, reveals that the improvements were maintained for 2.5 years after starting the treatment.

The research team, including members from Queen Mary University of London (QMUL), UK, published the findings in The Lancet Psychiatry. Coauthor Peter White, a professor in the Wolfson Institute of Preventive Medicine at QMUL, says: "The fact that these two treatments have long-lasting benefits is very encouraging."

Chronic fatigue syndrome (CFS) is a complex disorder characterized by a state of profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity. Symptoms may vary and include weakness, muscle pain, insomnia and problems with memory and/or concentration. All of these symptoms can have a significant impact on the quality of life. In some cases, CFS can persist for years.

For the study, CFS was defined as having had fatigue and impaired functioning for at least 6 months and for which there was no identifiable alternative diagnosis. The authors note that while myalgic encephalomyelitis (ME) is often perceived as the same disease, there are those who consider it a distinct state.
The new study is a follow-up to the PACE trial, the results of which were published in 2011.

Improvements after one year of cognitive behavioral therapy and graded exercise therapy

In the original PACE trial, 641 patients with CFS were randomly assigned to four treatment groups: specialist medical care (SMC) alone, SMC plus cognitive behavioral therapy (CBT), SMC plus graded exercise therapy (GET) or SMC plus adaptive pacing therapy (APT). Three quarters of the trial participants took part in the follow-up.

Specialist medical care (SMC) involves giving advice to the patient on how to manage the disease and any accompanying medication. CBT can be seen as a “talking therapy”, i.e. helping patients understand how thinking can affect their symptoms and encourages them to experiment with increasing levels of activity. GET is about patients gradually exercising more in a monitored program tailored to their individual symptoms and fitness. And APT helps patients adapt their lives to live better within the limits of their condition.

The earlier 2011 study found that outcomes for CBT and GET were better than either SMC alone or APT, and this was still the case after 1 year of follow-up. In the new study, the team found that the improvements achieved after 1 year of CBT and GET were still there 2.5 years after treatment.

However, the patients reporting long-term worsening of their general health – about 1 in 10 patients in each of the four treatment group – showed no significant difference as to the impact of each treatment.

Prof. White notes:
“(These results are) also a reminder that these treatments do not help everybody, and more research is needed into finding other treatments that help."

Author: Catharine Paddock PhD - 11/2015
Text abridged and adapted
With kind permission to publish from MNT
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