Chronic Fatigue Syndrome is a disorder that has long been surrounded by questions and unknowns. CFS is a painful and debilitating illness and the cause is unclear. There is no test to diagnose the condition. CFS is also a chronic disorder without a cure. Chronic fatigue syndrome consists of a number of symptoms, including disabling mental and physical fatigue, chronic pain, and problems with concentration and memory. Sleep problems are common among patients with CFS, particularly excessive daytime sleepiness, non-refreshing sleep, and sleep disorders such as insomnia and obstructive sleep apnea.
New research suggests there may be a path to recovery for people suffering from CFS. A large-scale study suggests that recovery from chronic fatigue is possible, and is significantly more likely when patients are treated with certain combinations of therapy. A team of researchers in the United Kingdom, led by scientists at Queen Mary, University of London, conducted a five-year study of treatments for CFS. They found that both cognitive behavioral therapy and exercise therapy, used in conjunction with specialist medical care, led to significant improvement in symptoms of CFS. For some patients their symptoms improved to the point that researchers considered them recovered from the condition.
The PACE study included 640 patients who had been diagnosed with chronic fatigue syndrome. Each patient was randomly assigned to one of four treatment groups for a year of therapy. The four groups consisted of different types of therapy already in use to treat CFS:
Specialist medical care (SMC): In this treatment group, patients received advice from physicians with a specialty in treating chronic fatigue. Specialists either prescribed medication or advised patients’ primary physicians on prescriptions to treat symptoms of CFS, including insomnia and chronic pain. Patients in this group were advised to seek out self-help treatments. This group was the only one encouraged to employ self-help treatments at their own discretion.
Cognitive Behavioral Therapy (CBT) with SMC: In this group, patients received specialist medical care and also engaged in cognitive-behavioral therapy. Under the therapeutic guidance of clinical psychologists or nurses, patients in this group worked to understand how their thought patterns about chronic fatigue might affect their symptoms and their choices about how to manage those symptoms. Gradually, patients in this group were encouraged to increase their levels of activity.
Graded Exercise Therapy (GET) with SMC: In addition to receiving specialized medical care, patients in this group also worked with physiotherapists to design exercise plans according to their individual symptoms and fitness levels. Over time, these patients gradually increased their exercise and activity levels.
Adaptive Pacing Therapy (APT) with SMC: Patients in this group worked with specialized physicians, as did the other groups. These patients also worked with occupational therapists to adapt their activity levels to their individual energy levels. In this type of therapy, the goal is to adapt to the condition rather than attempting to push beyond its limits, in terms of energy and activity.
In previously analyzed results from the same study, researchers found that both CBT and GET, in conjunction with specialized medical care, resulted in greater improvements to chronic fatigue symptoms than either specialized medical care alone or in conjunction with APT. In their follow-up analysis, researchers investigated how well these therapies might work to bring patients to a full recovery from their condition. Researchers defined a patient as “recovered” if they no longer met the diagnostic criteria for CFS, using the same criteria that made them eligible to participate in the study. This included the elimination of unusual fatigue and physical pain or disability. In addition, in order to be considered recovered from CFS, patients themselves had to describe their health as either “much better” or “very much better.”
Similar to their earlier analysis, they found that both cognitive-behavioral therapy and graded-exercise therapy brought the most significant improvements to patients, and resulted in the greater likelihood of recovery. Among the patients in each group:
- 22% of patients who received CBT or GET recovered from chronic fatigue
- 8% of patients who received APT were classified as recovered
- 7% of patients who received only SMC improved to the point of recovery
It is important to note that researchers consider recovery to be confined to what they refer to as the “current episode of the illness.” Researchers considered patients recovered when their symptoms disappeared. But their results do not predict whether the symptoms will re-appear over time. Researchers acknowledge the need for further study to determine if long-term recovery is possible for patients with chronic fatigue using these therapies.
Still, this is encouraging news for people who suffer from this debilitating illness. I’ve written before about the value of both cognitive behavior therapy and exercise in improving health and overall sleep. For patients with chronic fatigue, these therapies may offer a path to improved health and well being.
Michael J. Breus, PhD
The Sleep Doctor™