Chronic fatigue syndrome/myalgic encephalomyelitis: More heat, some light-directions for research and clinical practice

Abstract

Comments on an article by C. Smith & S. Wessely (see record 2014-03300-022). In the paper by Smith and Wessely, problems are outlined in commissioning services in Scotland that accommodate the acrimonious debate between the views of those who consider myalgic encephalomyelitis (ME) to be a neurological condition versus an evidence-based medicine view that chronic fatigue syndrome/ myalgic encephalomyelitis (CFS/ME) is a condition of uncertain aetiology improved by graded exercise treatment (GET) and cognitive behaviour therapy (CBT). A wide range of diagnostic criteria are used in research and clinical practice that differ in terms of duration of chronic fatigue as a central symptom (3, 4 or 6 months), the requirement or not for postexertional fatigue lasting more than 24 h, additional symptoms or diagnoses of exclusion. Factors such as number of symptoms and postexertional malaise did not predict outcome in recent large randomised controlled trials (RCTs) in primary and secondary care, although depression symptoms and duration may do. In summary, GET and CBT are effective and safe in CFS/ME when given by trained and supervised specialist therapists but research is required into alternative or more intensive treatments for those who do not recover with GET and CBT, or have severe CFS/ME. Such RCTs should not use exercise capacity on a treadmill as a primary outcome measure as improvement in exercise capacity is neither necessary nor sufficient for symptomatic and functional improvement. (PsycINFO Database Record (c) 2016 APA, all rights reserved)