News Medical Life Sciences Website: What is Chronic Fatigue Syndrome?

[Sly Saint]

Chronic fatigue syndrome is a condition that leads to symptoms of persistent fatigue that do not resolve after rest or sleep.

The medical term used for this condition is myalgic encephalomyelitis and chronic fatigue syndrome is also know of as ME. The term myalgic encephalomyelitis can be broken up into “myo” meaning muscle, “algia” meaning pain and encephalomyelitis meaning inflammation of the brain and spinal cord.

In three quarters of all patients with this condition, the symptoms are mild to moderate. In the case of mild symptoms, patients can usually take care of themselves but may take time off from work to rest. Moderate symptoms can cause mobility problems and disrupted sleep patterns. In severe cases, individuals may be able to carry out the most simple of tasks such as washing their face but mobility is significantly reduced and concentration is diminished.

ugh

According to criteria form the National Institute of Health and Clinical Excellence (NICE), the fatigue criteria that need to be fulfilled for a diagnosis of chronic fatigue syndrome include:

• No previous history, so new onset
• Persistent
• Unexplained by other conditions
• Substantially impacts on activity level
• Feels worse after physical activity

In addition, one or more of the following criteria need to be met:

• Sleeping difficulty or insomnia
• Difficulty thinking or concentrating
• Headache
• Joint pain
• Sore throat
• Painful lymph nodes
• Worsening of symptoms after activity
• General malaise or flu-like symptoms
• Dizziness
• Nausea
• Heart palpitations

"fatigue criteria"? this looks more like the old guidelines.

it is, the link goes to the 2007 NICE guidelines.

Treatment
Chronic fatigue syndrome cannot be cured and treatment is aimed at reducing symptoms. Some of the most common treatments used are cognitive behavioural therapy (CBT), graded exercise therapy and medications that alleviate pain, sleep disturbances and nausea.

they also link to an old CDC cfs-toolkit pdf but thankfully the link now takes you to the main CDC site..... although they obviously are unaware.

https://www.news-medical.net/health/What-is-Chronic-Fatigue-Syndrome.aspx

 

[Sly Saint]

same website; from 2015, interview with Trudie Chalder
Exercise and chronic fatigue syndrome: an interview with Professor Trudie Chalder

Prof. Trudie ChalderTHOUGHT LEADERS SERIES...insight from the world’s leading experts

How do existing treatments for CFS try to reduce fatigue and improve physical function?The two most effective treatments are cognitive behaviour therapy (CBT) and graded exercise therapy (GET).

CBT is a talking therapy. The patient and therapist usually meet every week or fortnight to negotiate a way forward.

This involves setting goals that have been mutually agreed. They should be specific behaviours that are practiced regularly. They should be set at a level that is achievable at times when symptoms are at their worst as well as times when symptoms are less troublesome.

The purpose of the goal setting is to reduce fear associated with doing things and to slowly build up confidence again.

Goals often involve changing habits around sleeping in order to help improve the quality of people’s sleep.

Certain unhelpful thoughts would be discussed and alternative ways of thinking about things would be generated mutually and then individually by the individual.

In the case of an individual who is booming and busting they would be encouraged to be consistent in order to bring about some stability.

They may then be encouraged to build up activities as and when they feel able. For those who take on too much they may be encouraged to cut back and acknowledge achievements to themselves.

GET focuses primarily on exercise and in the first instance patients are encouraged to set goals around exercise that feel manageable five times per week.

In addition they are encouraged to adopt a regular sleep routine. Like CBT the goals are modest and in keeping with the individuals ability at the time. A consistent approach is important.

Initially patients are encouraged to increase the time they exercise and engage in activity. Subsequently, they are encouraged to increase the intensity of the exercise to a target of 30 minutes 5 times a week.

Please can you outline the PACE trial that was published in The Lancet in 2011. What were the main findings of this study?We compared four different treatment approaches for CFS in the context of a clinical randomised controlled trial. They were specialist medical care alone and CBT, GET and adaptive pacing therapy (APT) when added to SMC.

We found that CBT and GET when added to specialist medical care (SMC) worked better than adaptive pacing therapy (APT) added to SMC and SMC alone in reducing fatigue and improving physical functioning.

Recently, there was a new analysis of data from the PACE trial. Why was this analysis conducted and what did it involve?
In our recent research we were interested to find out how treatment worked. We had already shown that CBT and GET when added to specialist medical care (SMC) worked better than adaptive pacing therapy (APT) added to SMC and SMC alone.

The main finding in the new study was that CBT and GET worked by reducing people’s fear of engaging in activity. In GET tolerance of walking was also important for bringing about improvements in fatigue and physical functioning.

What are fear avoidance beliefs and what impact did you find they had on the overall effect of cognitive behaviour therapy (CBT) and graded exercise therapy (GET) on outcomes?
An example of a fear avoidance belief is “I am afraid that I will make my symptoms worse if I exercise”.

Up to 60 percent of the treatment effect was explained by change in these beliefs.

How did this compare to the other mediating factors that were analysed?
Fear avoidance beliefs was the strongest mediator but we found change in other beliefs and behaviours also mediated the treatment effect but to a lesser extent.

Were you surprised by your results and what impact do you hope they will have?
We were not surprised by our findings as patients often describe in great detail their understandable concerns about engaging in activity.

Where can readers find more information?
Readers may be interested to read more about the approach we used in which case the treatment manuals are freely available on the pace trial website (www.pacetrial.org)

Exercise and chronic fatigue syndrome: an interview with Professor Trudie Chalder (news-medical.net)

(nb, that link to the PACE trial info works ie www.pacetrial.org).