People with chronic fatigue
syndrome should be offered talking therapy
and exercise therapy, research suggests.
The work in the Journal of
the Royal Society of Medicine was commissioned
by the NHS's drug advisor NICE, which is drawing
up guidance for doctors.
In the study, CFS - also
known as ME (myalgic encephalomyelitis) -
responded best to the therapies. Drug treatments
had little benefit.
There is controversy over
the causes of CFS and how to treat it.
ME
Some say the causes are predominantly
biological, while others claim there is a
strong psychological element.
CFS was officially recognised
as a genuine illness in the UK by the Royal
Colleges of Physicians and General Practitioners
in October 1996.
Up to 240,000 people in the
UK have CFS. People with the condition experience
prolonged fatigue and a number of other symptoms,
including headaches, poor sleep and joint
and muscle pain.
CFS is not contagious, but
viral infection, stress and toxins have all
been suggested as possible triggers.
To assess which treatments
work best, Mr Duncan Chambers and colleagues
at the University of York looked at 70 individual
CFS studies.
Cognitive behavioural and
exercise therapies appeared to reduce symptoms
and improve physical function in adult patients
with CFS.
Most pharmacological treatments,
such as antidepressants, showed no benefit.
Immunological and antiviral
treatments did show some beneficial effects
but they were also associated with harmful
side-effects.
Homeopathy and supplements
such as essential fatty acids and magnesium
showed some small beneficial effects in single
trials. But Mr Chambers said more trials were
needed to be sure of this.
Mounting evidence
He said the last five years
had seen a significant increase in the size
and quality of the evidence base on interventions
for CFS, however, more research was required
into all treatments.
The draft guideline from
the National Institute for Health and Clinical
Excellence (NICE) recommends that when an
adult or child's main goal is to return to
normal activities, the therapies of first
choice should be cognitive behavioural therapy
or graded exercise therapy.
It warns against unstructured,
vigorous exercise as this may worsen symptoms.
Andrew Dillon, chief executive
of the National Institute for Health and Clinical
Excellence (NICE) , said: "CFS can cause prolonged
illness and disability, which has a substantial
impact on patients and their families.
"Uncertainties about diagnosis
and management, and a lack of clinical guidance
for healthcare professionals has exacerbated
this impact.
"A national best practice
guideline from NICE will help those working
in the NHS to provide effective support, and
we look forward to hearing the views of patients,
carers, families and healthcare professionals
during consultation."
