The Pharmaceutical Journal: Chronic fatigue: it is time to take its treatment more seriously - by Christine Parry

[Kalliope]

Quotes:

“One in four consultations in primary care involve fatigue — it’s the most common reason why people go to see their GP,” says Julia Newton, a consultant physician with an interest in fatigue at Newcastle upon Tyne Hospitals NHS Foundation Trust.

At least 250,000 people in the UK live with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and self-reported data indicate that 50% of people with chronic conditions — such as rheumatoid arthritis, cancer, Parkinson’s disease, or multiple sclerosis (MS) — struggle with tiredness[1–3]. “Despite that, there’s very little research,” points out Newton.

...

There are currently no approved pharmacological or non-pharmacological interventions for chronic fatigue; the 2021 revision of the National Institute for Health and Care Excellence’s (NICE’s) guidance for managing ME/CFS removed a previously recommended therapy — graded exercise therapy (GET), a programme of fixed, incremental increases in exercise — and downscaled the scope of another — cognitive behavioural therapy (CBT) — because a re-evaluation of the evidence base for these therapies failed to show meaningful benefit.

...

We talk about the three Ps approach — prioritising, planning, and pacing,” says Rachel Rogers, a fatigue specialist occupational therapist at the long COVID clinic based at Churchill Hospital, Oxford, and clinical lead for Oxfordshire’s ME/CFS service. Rogers describes the patient journey for someone presenting with long COVID fatigue.


...

The article also lists several ongoing research projects

https://pharmaceutical-journal.com/...-is-time-to-take-its-treatment-more-seriously

 

[Arnie Pye]

Yet another article which conflates tiredness with fatigue, and chronic fatigue with ME/CFS.

 

[Sly Saint]

1 comment

Chronic fatigue is something completely different to ME/CFS. This is written with the terms confused. The complex multisystem disease, ME/CFS, see NICE Guideline ME/CFS 2021, is marked out by the symptom Post Exertional Symptom Exacerbation which includes fatigue (understatement to the point of being absurd) as well as other symptoms. It is not defined by fatigue. Chronic fatigue on the other hand just means fatigue that has become chronic, it is a single symptom that can arises from any number of other conditions such as multiple sclerosis, arthritis or even depression. It seriously doesnt help when articles confuse the two, and causes even more harm when research cohorts confuse the two - the results end up useless and potentially even harmful. Please correct the title so it is clear which of these two things the article is about, is it about the disease ME/CFS as in the NICE Guideline, or is it about the symptom of something else,, chronic fatigue? Thanks

 

[Hutan]

That's a dispiriting article all round.

There's Julia Newton who has contributed as much to the confusion between chronic fatigue and ME/CFS as anyone talking about new horizons:

“I am excited and optimistic that this represents a new horizon for those with this terrible illness that will provide opportunities for new treatments and a greater understanding of the impact ME/CFS has on people’s lives,” says Newton, who is a participant at the roundtable.
Chronic fatigue research has an uphill journey ahead of it, but it seems to be finally moving in the right direction.

Perhaps if she had done her 2011 study properly and not suggested ME/CFS could be fixed with more physical activity we'd be a bit further ahead now:

Conclusion: Low levels of physical activity reported in CFS represent a significant and potentially modifiable perpetuating factor in CFS and are not attributable to high levels of sedentary activity, rather a decrease in physical activity intensity.

Physical activity intensity but not sedentary activity is reduced in CFS and is associated with autonomic regulation, 2011, Newton et al
Why on earth is she participating in any discussion on how to make things better for people with ME/CFS? She contributed to the problem; as far as I can see, she still does in her Fatigue Clinic. She should not be part of the solution.

And then there's the list of treatments being trialled, with a high concentration of quackery, including this trial of a commercial device funded by the NIHR:

But research efforts are not stopping at supportive tools; another study, receiving £640,180 of NIHR funding, is the Percutaneous Auricular Nerve Stimulation for Treating Post-COVID Fatigue (PAuSing-Post-COVID Fatigue) study, which applies electrostimulation to the auricular vagus nerve, in an intervention known as neuromodulation[10]. “It’s what is increasingly referred to as an ‘electroceutical’,” says lead investigator Mark Baker, senior clinical lecturer at Newcastle University.

Investment in drug-based therapies for chronic fatigue is also trickling through; an early front-runner to reach phase IIb testing in the UK is clinical-stage biotechnology sponsor Axcella’s candidate AXA1125[13,14]. An oral powder mix of six amino acids,

Similarly, Ageless Rx, a US-based telehealth ecommerce start-up, is testing two candidates in a 12-week pilot study of 60 subjects with fatigue following COVID-19 infection[21,22]. The first intervention, oral low-dose naltrexone (4.5mg), picks up from several previous studies indicating low-dose naltrexone improved fibromyalgia symptoms, including fatigue[23,24]. The second intervention, topical patches of the metabolic enzyme nicotinamide adenine dinucleotide (NAD+), is another targeted at cell energy processing[25].

In June 2022, Terra Biological, also based in the United States, reported positive results from a small proof-of-concept trial in ME/CFS and long COVID fatigue patients with its nutritional supplement oxoalocetate[26].