Norway: 2026 Guidelines for chronic fatigue and ME/CFS - draft published

Kalliope

Kalliope

Senior Member (Voting Rights)
For comment on the development of the guidelines, see Norway: 2025-2026 Chronic Fatigue and ME/CFS Guidelines - Development
Link to the draft here



I think these guidelines need a separate thread. There's been some posts about them in the Scandinavia thread, but here is a good intro in English from David Tuller (thank you!!) who has interviewed Trude Schei from the Norwegian ME Association about the guidelines. She has been one of the patient representatives in the advising working group and has taken dissent after the draft got published.

Trial by Error: Norway's Problematic Draft Guideline Combining Long-Term Fatigue and ME/CFS

Quote:

Negatives, in no particular order:

  • We lose sight of ME/CFS as a separate disease

  • Overall, the guideline is confusing.

  • Getting an ME/CFS diagnosis has no implications for further treatment.

  • Doctors do not have to make a diagnosis, even if symptoms are present.

  • Other symptoms of ME/CFS are not addressed, like POTS.

  • The very real danger of deterioration as a result of too much activity/exercise/repeated PEM is not communicated in a meaningful way. Compare that to the section of medication, where side effects are clearly communicated! Patient participation and informed consent in treatment is an important thing in Norway, but how can a patient give informed consent to treatment if the risks are not communicated?

  • There is no mention of the fact that ME/CFS can be life-long, and that patients will need ongoing care.

  • There is no mention that many experience a fluctuating course of illness, and that care may have to be adjusted over time. The guideline suggests functional capacity evaluation as a one-time thing – but patients will have varying degrees of severity over time, and will need varying levels of help.

  • The guidelines give an unrealistically positive impression of likely prognosis and of the possibility that a case of ME/CFS will be of short duration. This bias could create problems for patients. If schools, welfare officials and health care personnel expect improvement as the standard course, they may end up blaming the patients themselves for their illness. This issue arises currently when child protection services get involved because children with ME/CFS do not improve as expected.

  • The severity of ME/CFS is inadequately addressed. There is chapter about “care in the home” but the perspective of severe ME/CFS is absent in the other parts of the guideline.

  • The guidelines are supposed to be based on both research, patient experience and clinical experience. Consensus documents on treatment, like Euromene and ICC, or clinical experience from Bateman Horne, are, however, not taken into account. Hdir claims doing so would “undermine” the work in the working group, and that they are only looking at Norwegian experience (???? Based on the two GPs who were there, who had seen a very limited number of patients???) When it comes to patient experience, they do not cite any of our survey reports, and they compare a few anecdotes from Recovery Norway with reports large, structured surveys. This gives equal weight to a large body of well-documented experiences, and a few anecdotes.

  • The guideline is wordy but vague and unclear. This leaves it open to interpretation, and my fear is that if it stands, everyone can find something in there to support their own point of view.


Trial By Error: Norway's Problematic Draft Guideline Combining Long-Term Fatigue and ME/CFS | Virology Blog

By David Tuller, DrPH On February 4th, the Norwegian Directorate of Health published a draft of a “national professional guideline” for diagnosis, managemen ...
virology.ws virology.ws
 
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There have been some opinion pieces on the guidelines draft already. Yesterday the researchers Anne Kielland and Arne Backer Grønningsæter wrote a very good one summarising the debate so far. They are from the research project Tjenesten og MEg who studies ME patient's meeting with the health care services.

In this opinion piece they write that everyone is a bit right on chronic fatigue, but that people are talking past each other. "The challenge arises when studying different patient groups, but generalising the finding to all those suffering from long-term fatigue".

"Based on our research, our most important input to the guidelines remains to differentiate treatment recommendations for patients with ME/CFS and the group struggling with other long-term fatigue"

www.aftenposten.no

Alle har litt rett om langvarig utmattelse

Debatten preges av at man snakker forbi hverandre.
www.aftenposten.no www.aftenposten.no

google translation: Everyone is a little bit right about long-term fatigue
 
The ME Parents, one of the user organisations in the working group of the guidelines draft, and who recently took dissent sent a letter today to the Directorate of Health asking for distinguishment between ME and other fatigue. They've shared the letter in full on their website with an intro with these news:


In the letter, we refer to extensive email material from 2024–2025 in which Per Fink has been in ongoing dialogue with consultants at Implement Consulting Group, who are preparing a report on ME/CFS on behalf of the Danish National Board of Health.

The correspondence shows how Fink actively attempts to influence both the use of terms, understanding of the disease and the knowledge base in the work. In this dialogue, Fink also recommends Norwegian professionals as sources of information about the situation in Norway. In the e-mail correspondence, he forwards, among other things, a response from Vegard Bruun Bratholm Wyller at the University of Oslo.

Wyller writes: “I myself have no clinical activities at the moment, but Maria Pedersen (postdoc in my group) also has a clinical position at Oslo University Hospital that involves treating patients with CFS/ME and other functional conditions. Tom Farmen Nerli, who is a PhD student with me, has his primary affiliation with the Coastal Hospital in Stavern, a rehabilitation institution with long experience with this patient group. Together, I think we can say that we represent the “state-of-the-art” in Norway.”

In this formulation, CFS/ME is explicitly mentioned together with “other functional conditions”, while the environment describes itself as “state-of-the-art” in Norway. Norway is described in the correspondence as a country that is moving towards the same approach as practiced in Denmark. Thus, we risk a situation where Norway and Denmark may come to refer to each other as justification for the same framework of understanding.

This can develop into a form of circular reasoning that in practice contributes to placing ME within a functional understanding of the disease – without a clear and open decision being made about such a redefinition. In that case, it would have major consequences for patients with ME.

www.me-foreldrene.no

ME-foreldrene til Hdir: Skill mellom ME og «annen utmattelse»!

ME-foreldrene har i dag, 4. mars 2026, sendt et brev til Helsedirektoratet der vi ber dem etablere et eksplisitt og operativt skille mellom sykdommen ME – hvor utmattelse kun er ett av mange sympto…
www.me-foreldrene.no
 
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