Chronic Fatigue Syndrome: What Works?

It has been called everything from "the yuppie flu" to nonexistent. But Chronic Fatigue Syndrome was given its due last month when the Journal of the American Medical Association published a systematic review of all relevant studies to determine which treatments are effective. Results favored two non-drug interventions.

Chronic Fatigue Syndrome is a constellation of symptoms that include headache, fatigue, sleep disturbances, impaired concentration, and musculoskeletal pain. The cause of CFS is unknown, but experts have considered a range of possibilities, such as viral, hormonal, immunological, or psychological disturbances. Among the many treatments for CFS are exercise, dietary supplements, antidepressants, corticosteroids, cognitive behavioral therapy, immunotherapy, and prolonged bed rest.

Penny Whiting, MSc, of the University of York, England, and colleagues searched 19 databases for both published and unpublished CFS treatment studies. Forty-four trials were found with a combined total of 2,801 participants. Two interventions were deemed useful: exercise and cognitive behavioral therapy. "Neither is remotely curative," observed Simon Wessely, MD, in an editorial that accompanied this review.

The type of exercise program shown to benefit people with CFS has them slowly build up their level of activity to 30 minutes of exercise a day. This approach called graded exercise involves weekly individual sessions. The other effective method, called cognitive behavioral therapy, must be administered by highly skilled therapists who encourage people with CFS to exercise at home and feel less helpless. This form of therapy is usually given in biweekly 30-60 minute sessions.

Whiting and colleagues offered many cautions regarding their findings. There were not many high-quality studies to review, an unfortunate situation made worse by inconsistencies in how CFS is defined. Most of the CFS treatments have been evaluated in only one or two studies. And some trials might have excluded the "worst cases" because participation was limited to those who were able to get to a clinic regularly. The trials had a dropout rate of 15%. Behavioral therapies were unacceptable to many people; this intervention had the highest drop out rate (19%).

The findings of this review were confirmed by another independent team of reviewers. Still, Dr. Wessely's editorial warned of how polarized the subject of CFS and its treatments has become. He called for consumers and doctors to work together to encourage more high-quality trials with longer followups to provide good evidence that may help people with CFS.

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By Maryann Napoli

Maryann Napoli is the associate director of the Center for Medical Consumers in New York City.

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