Introduction

Chronic fatigue syndrome (CFS) is a distressing disorder in which there's considerable disagreement between health professionals as to its cause, or causes, what symptoms it includes, and the best way to treat it. Added to this is the fact that there are a large number of different treatments, all of which are rather unsatisfactory. Not surprisingly, many sufferers turn to alternative, or complementary medicine, in their search for relief. In this summary, we'll consider what's known to be effective in helping patients with CFS.

What is CFS, exactly?

According to the US Center for Disease Control, people with CFS must have severe chronic fatigue for six months or more (without any known medical conditions that might be causing this), together with 4 or more of the following: difficulty in concentration, sore throat, tender lymph glands, muscle pain, joint pains (without swelling or redness), headaches, unrefreshing sleep, and tiredness after exertion that lasts 24 hours. ¹

The cause is not known; indeed, there may be several causes. This makes it much harder to treat than a condition where the cause is known, and can be removed or treated precisely.

CFS can occur at any age, and is seen in both men and women; it's diagnosed more often in women, however. It is sometimes called myalgic encephalitis (ME), or postviral fatigue syndrome (PVFS). There have been suggestions that it's related to the Gulf War Syndrome. There are no specific lab tests or diagnostic clinical signs.

What can be done?

British researchers have recently published a review of all suitably controlled clinical studies of treatments for CFS in the Journal of the American Medical Association. Here is a summary of their findings.

A total of 44 studies were found, and each was given a score (out of 20, according to set standards) that reflected their reliability. They were then classified into those showing any effect (which meant that one measure of effectiveness was improved), an overall effect (which meant that two or more measurements of effectiveness were improved), or no effect of treatment. There were 38 different measures of effectiveness -- these could be psychological, physical, physiological or a measure of quality-of-life.

There were 30 different treatments, which were grouped into 6 categories for the purpose of analysis.

Results

Over 2,800 participants were included in the 44 trials. Ages ranged from 11 to 87 years, 71% being women. Some participants had had CFS for only 27 days, others for up to 34 years.

In 29 of the trials (66%), some effect of treatment was seen, while in 18 (41%) an overall beneficial effect was found. That's really a fairly good result, considering the wide variety of treatments tested.

When the number and the quality of the studies were considered, two forms of treatment surfaced as being most helpful -- graded exercise therapy and cognitive behavioral therapy.

Graded exercise therapy (GET) is just what it says it is - progressive scheduling of activities, starting with low effort physical and social tasks and increasing to more demanding endeavors as tolerance to exertion improves. Each patient is encouraged to develop an exercise program which is tailored to his or her own needs, and which is very, very gradual. One might start by spending only a few minutes on an exercise bike, or maybe just walking to the end of the block.

Cognitive behavior therapy (CBT) combines two very effective kinds of psychotherapy ---- cognitive therapy and behavior therapy:

• Behavior therapy is designed to break down the connections that have been built up between troublesome situations and habitual reactions to them -- some of which may include symptoms of CFS. It also teaches how to calm the mind and body, so one can think more clearly and make better decisions.
• Cognitive therapy helps the patient to recognize how some thinking patterns can cause symptoms, by giving a distorted picture of what's actually happening, producing anxiety, depression, or anger. The intent is to alter the patient's way of thinking.

Combining these two approaches in CBT provides a powerful tool to correct psychogenic causes of physical symptoms. They each had a 66% success rate providing overall relief from CFS symptoms in the 9 studies analyzed. There were no side effects of treatment.

Unfortunately, both CBT and GET had high drop-out rates -- 19% and 18% of participants stopped the treatment process before it was completed. This may represent a feature of both forms of treatment, namely that they try to address something in the patients' minds rather than in their bodies.

Other treatment types in the studies were immunological approaches (gamma-globulin, interferon or Ampligen injections), medicines (hydrocortisone, fludrocortisone, or other drugs), supplements (essential fatty acids, magnesium), and alternative medicine (massage, osteopathy). None were clearly effective, and most carried the risk of some side effects.

Conclusions

The wide variety of treatments tested reflects both the uncertainty of the cause of CFS, and the unsatisfactory results of treatments. It seems fairly clear that two treatments (graded exercise therapy and cognitive behavioral therapy) have been the best investigated, and have the greatest chance of producing good results.

CFS is a difficult disease to study, but intensive research into its cause (or causes) is clearly worthwhile, as this offers the best way to find a really successful treatment.