Review: Chronic Fatigue Syndrome, 2020, Sapra

[Andy]

Chronic fatigue syndrome is a chronic disease that potentially affects about two million Americans.[1] The United States Public Health Services initially described it during an epidemiological study of Los Angeles County during the summer of 1934. Chronic fatigue syndrome, also called myalgic encephalomyelitis, is a complex multisystem disease commonly characterized by severe fatigue, cognitive dysfunction, sleep problems, autonomic dysfunction as well as post-exertional malaise, severely impairing activities of daily living. Things get worsened due to the condition remaining undiagnosed for years secondary to inadequate medical teaching on the subject, provider bias, as well as confusion regarding diagnoses and treatment of the disease.

https://www.statpearls.com/kb/viewarticle/21640

 

[Wonko]

Wow.

How can they start listing so many 'things' that have been found 'different', and then not wonder how on earth CBT and GET could possibly positively affect them. What thought processes lead to the conclusion that CBT and GET could possibly do anything useful, and why.

It's got to be the fluffy dice theory.

People with fluffy dice in their cars may tend to have more accidents therefore making fluffy dice illegal must logically make peoples driving better.

 

[Sean]

Treatment / Management
Non-Pharmacologic Management

The primary treatment modalities are cognitive behavior therapy (CBT) and graded exercise therapy (GET).

A randomized control trial conducted in 2011 in the United Kingdom compared the effectiveness and safety CBT, GET, adaptive pacing therapy (APT), and specialist medical care in the management of chronic fatigue syndrome. Overcoming fatigue and improvement of physical function were taken as measures of effectiveness while safety assessment comprised of recording all adverse effects. The results showed that both CBT and the GET improved outcomes when added to, whereas APT was not a useful addition.[77]

Treatment for any comorbid condition should be undertaken to minimize symptom burden.[80][85]

Cognitive Behavior Therapy (CBT)

During the CBT sessions, the therapist emphasizes the role of thought process and its impact on the patient’s actions and feelings as well as recognize behaviors which cause them to feel more tired and hence minimize them. Multiple trials, as well as Cochrane reviews, have shown the positive benefits of CBT on improving the fatigue, mood, and post-exertional malaise in both the adolescent and adult patients.[77][85][86][87][88] Studies have also shown lower school absences when CBT is provided to the adolescent population.[89]

Graded Exercise Therapy (GET)

GET involves a supervised, gradual increase of physical activity intensity and duration. This therapy got much publicity after the PACE trial, which showed effectiveness for fatigue and functional impairment with the GET.[77] The trial encouraged the participants to gradually increase the timing of their physical activity to a final goal of 30 minutes, spread over 52 weeks to a final goal of 30 minutes of light exercise five days per week while trying to avoid overexertion. Other studies have also supported its efficacy.[90][91][92]

 

[Forbin]

Even though chronic fatigue syndrome has fatigue as one of the three mandatory symptoms, it is a complex multisystem neurological disease with evidence of inflammation at the brain. Hence, the term myalgic encephalomyelitis, a neurology consultation can be useful when indicated. The main non-pharmacological treatment modalities are cognitive behavior therapy and graded exercise therapy.

Well, it goes without saying that CBT & GET would be useful in addressing the fatigue induced deconditioning that's at the root of your brain inflammation (!).

[This is actually a pretty thorough article though, if somewhat incurious about its internal contradictions.]

 

[Hutan]

The authors are based at the Southern Illinois University School of Medicine.

The publisher is StatPearls.

Content is updated daily by over 6,000 academic contributors to provide the most accurate information. Over 2,000 professional schools, training programs, and hospitals worldwide use StatPearls.

So I think it looks like random people can write an article by googling a bit with limited understanding, publish it through StatPearls and then add a review article to their CV. And then StatPearls provides the collection of review articles and related questions to 'over 2,000 professional schools, training programs and hospitals world-wide'.

While I shake my head at all the stuff that is wrong in the article, I'm not sure how many people will ever actually read it. It's hard to know if this is something to spend time on or not.

 

[Trish]

Maybe one for @dave30th to tackle. It would be good to get this junk removed, even if only a few people read it.

 

[Peter T]

Things get worsened due to the condition remaining undiagnosed for years secondary to inadequate medical teaching on the subject, provider bias, as well as confusion regarding diagnoses and treatment of the disease.

Though this is likely to be the case for some people with ME, it does sound like an enormous vague generalisation that lacks a clear evidence base. What are the ‘things’ assumed to worsen, and surely it depends on what treatment they get. Most people with ME would argue that GET would make them worse, so we we might expect on the basis of this that some at least get worse following diagnosis and referral to the harmful GET, that for some they might have done better therefore being undiagnosed.

There is some evidence/suggestion that people who attend up attending specialist ME/CFS services in the UK, which are primarily based on GET/CBT, experience objective deterioration as measured by subsequent regular hours in employment or levels of benefit state claimed. They might arguably have been better off literally and metaphorically without this service.

Further a number of people with ME seek to conceal their diagnosis in medical settings. Presumably they believe that this diagnosis is actually harmful to them achieving access to good medical care for other biomedical symptoms.

 

[Snowdrop]

It does look thorough. And all of it is backed up with legitimate pubmed references.

It could be that this person is unaware of the problems with some of the studies particularly for GET CBT.

This would be an excellent example then of why reputable journals need to be more vigilant and careful in reviewing and parsing all the details and data of a study before publishing.

 

[Hoopoe]

This and the Edzard Ernst blog shows why The Lancet needs to acknowledge the problems with PACE. People continue to be misled.

 

[rvallee]

This and the Edzard Ernst blog shows why The Lancet needs to acknowledge the problems with PACE. People continue to be misled.

Sadly the lesson appears to be that as long as the PACE authors refuse to retract, nothing will happen. 3/4 of the authors of the retracted HCQ agreed to the retraction and it seems the other simply ghosted them. I don't know what Lancet would have done otherwise but requiring fraudulent authors to agree they presented fraudulent findings is a lot like only convicting people who agree they committed a crime while treating them with unearned respect to avoid offending them. That's a ridiculous process, self regulation never works when it conflicts with personal interest.

Though this is definitely a great opportunity to highlight PACE and how utterly morally bankrupt everyone involved in this is. If only things like fabricating evidence and outright lying about it meant anything in medical research. Oh well, it's just a matter of time. Justice grinds slowly but it only leaves dust in its wake.