Researchers identify promising treatments for chronic fatigue

The PACE trial, a randomised controlled trial (RCT) of 640 patients, compared the effects of four different treatments for CFS. The study found that supplementing specialist medical care with cognitive behaviour therapy (CBT) or graded exercise therapy (GET) increased participants' chances of recovery threefold compared to specialist medical care (SMC) alone or supplemented by adaptive pacing therapy (APT).

The trial, conducted collaboratively by researchers from the University of Oxford, King's College London, Queen Mary University of London and the Medical Research Council (MRC), is published today in Psychological Medicine.

Professor Michael Sharpe, University of Oxford co-principal investigator of the PACE trial and co-author of the latest paper, said: 'The rehabilitative treatments of CBT and GET for CFS have been controversial. This analysis of the PACE trial data shows that not only do they achieve improvements in the majority, but they can also lead to effective recovery in a substantial minority.'

Chronic Fatigue Syndrome is a debilitating long-term condition affecting around 250,000 people in the UK which causes extreme physical and mental fatigue. Symptoms include muscle and joint pain, disturbed sleep and both concentration and memory problems. Exertion typically worsens symptoms, which can make treatment of the condition challenging for healthcare professionals.

The specialised medical care offered to all participants in the study included advice on managing the condition as well as prescription medications to manage the symptoms. A quarter of the patients also received CBT involving consultations with clinical psychologists or specialist nurses. They helped patients to understand the influence of their mental attitudes on their physical symptoms, and encouraged them to increase physical activity.

Physiotherapists helped patients in the GET group to develop incrementally challenging exercise regimes tailed to their specific circumstances. And with APT, occupational therapists advise patients to match their activity levels to their own energy, rather than aiming to increase activity over time. This approach is more about adapting to the illness than trying to overcome it.

In the patient groups treated by CBT or GET, 22% of patients had recovered a year after being randomised to treatments. This compares with 8% of those receiving APT and 7% of those who received only SMC.

Previously published results from the PACE trial showed that both CBT and GET led to greater reductions in symptoms and disability than either APT or SMC. In this analysis the researchers have gone a step further and examined how many patients recovered from their illness after these treatments.

Recovery was assessed after one year. Patients were defined as having recovered when they no longer met several criteria used to diagnose CFS and assess eligibility for the study. Participants were only considered recovered if they met these criteria and rated themselves as being 'much' or 'very much better' in their overall health.

Lead researcher Professor Peter White of Queen Mary, University of London said: 'Some people may question the use of the term "recovery", and how to define when a patient is "recovered" was a key issue we faced. We focused on recovery from the current episode of the illness, and have used several measures of both symptoms and disability to give us the most complete picture possible. Further long-term analysis is needed to see if recovery is maintained long-term.'

Professor Trudie Chalder from King's College London's Institute of Psychiatry, said: 'The fact that people can recover from chronic fatigue syndrome is excellent news. Healthcare professionals can now be more confident in sharing this possibility with patients, many of whom are understandably concerned about their future.'