Recovery from refractory chronic fatigue syndrome with CBT and modafinil

2021 ◽  
Vol 14 (3) ◽  
pp. e240283
Author(s):  
Himanshu Garg ◽  
Maggie Douglas ◽  
Gordon Douglas Turkington ◽  
Douglas Turkington
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Full Time ◽  
Liaison Psychiatry ◽  
Permanent Disability ◽  
Fatigue Syndrome ◽  
Graded Exercise Therapy ◽  
Evidence Based Treatments ◽  
Social Recovery

Many patients with chronic fatigue syndrome (CFS) fail to derive benefit from evidence-based treatments such as cognitive–behavioural therapy (CBT) and graded exercise therapy leading to permanent disability. To discover whether a repeat prescription of modafinil might potentiate the benefits of CBT leading to social recovery as defined by 2 or more point improvement in energy and muscular pain/concentration and return to work or full-time training. Three patients with treatment-resistant CFS (mean duration 17.66 years) treated with modafinil and CBT in a Liaison Psychiatry clinic were retrospectively reviewed. Progress was reviewed at baseline, 4–6 months and 10–24 months. Patients rated their fatigue, pain and concentration using 10-point Likert scales. 2/3 achieved clinically meaningful improvements in energy and pain/concentration and 3/3 achieved social recovery. Modafinil, when prescribed over the medium term, would appear to be a potentially useful potentiating agent when added to CBT.

The concept of ‘illness without disease’ impedes understanding of chronic fatigue syndrome: a response to Sharpe and Greco

2020 ◽  
pp. medhum-2019-011807
Author(s):  
Steven Lubet ◽  
David Tuller
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Medical Humanities ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Behavioural Interventions ◽  
Fatigue Syndrome ◽  
Cognitive Behavioural ◽  
Graded Exercise Therapy ◽  
Objective Evidence ◽  
Graded Exercise

In a recent article in Medical Humanities, Sharpe and Greco characterise myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as an ‘illness without disease’, citing the absence of identified diagnostic markers. They attribute patients’ rejection of psychological and behavioural interventions, such as cognitive–behavioural therapy (CBT) and graded exercise therapy (GET), to a ‘paradox’ resulting from a supposed failure to acknowledge that ‘there is no good objective evidence of bodily disease’. In response, we explain that understandings about the causes of and treatments for medical complaints have shifted across centuries, and that conditions once thought to be ‘psychosomatic’ have later been determined to have physiological causes. We also note that Sharpe and Greco do not disclose that leading scientists and physicians believe that ME/CFS is a biomedical disease, and that numerous experts, not just patients, have rejected the research underlying the CBT/GET treatment approach. In conclusion, we remind investigators that medical classifications are always subject to revision based on subsequent research, and we therefore call for more humility before declaring categorically that patients are experiencing ‘illness without disease’.

scholarly journals Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 124 ◽  
Author(s):  
Vink ◽  
Vink-Niese
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Sick Leave ◽  
Chronic Fatigue ◽  
Myalgic Encephalomyelitis ◽  
Full Time ◽  
Fatigue Syndrome ◽  
Number Of Patients ◽  
Graded Exercise Therapy ◽  
Retirement Policy

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome leads to severe functional impairment and work disability in a considerable number of patients. The majority of patients who manage to continue or return to work, work part-time instead of full time in a physically less demanding job. The prognosis in terms of returning to work is poor if patients have been on long-term sick leave for more than two to three years. Being older and more ill when falling ill are associated with a worse employment outcome. Cognitive behavioural therapy and graded exercise therapy do not restore the ability to work. Consequently, many patients will eventually be medically retired depending on the requirements of the retirement policy, the progress that has been made since they have fallen ill in combination with the severity of their impairments compared to the sort of work they do or are offered to do. However, there is one thing that occupational health physicians and other doctors can do to try and prevent chronic and severe incapacity in the absence of effective treatments. Patients who are given a period of enforced rest from the onset, have the best prognosis. Moreover, those who work or go back to work should not be forced to do more than they can to try and prevent relapses, long-term sick leave and medical retirement.

scholarly journals The planning, implementation and publication of a complex intervention trial for chronic fatigue syndrome: the PACE trial

2015 ◽  
Vol 39 (1) ◽  
pp. 24-27 ◽  
Author(s):  
Peter D. White ◽  
Trudie Chalder ◽  
Michael Sharpe
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Medical Care ◽  
Physical Disability ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Intervention Trial ◽  
Fatigue Syndrome ◽  
Cognitive Behavioural ◽  
Graded Exercise Therapy ◽  
Graded Exercise

SummaryThe PACE trial was a four-arm trial of specialist medical care, compared with specialist medical care with a supplementary therapy: adaptive pacing therapy, cognitive–behavioural therapy or graded exercise therapy, for patients with chronic fatigue syndrome. The trial found that both cognitive–behavioural and graded exercise therapies were more effective than either of the other two treatments in reducing fatigue and improving physical disability. This paper describes the design, conduct and main results of the trial, along with a description of the challenges that had to be overcome in order to produce clear answers to the clinically important questions the trial posed.

Myalgic encephalomyelitis/chronic fatigue syndrome patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys

2017 ◽  
Vol 24 (10) ◽  
pp. 1318-1333 ◽  
Author(s):  
Keith Geraghty ◽  
Mark Hann ◽  
Stoyan Kurtev
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behavioural Therapy ◽  
Exercise Therapy ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Myalgic Encephalomyelitis ◽  
Fatigue Syndrome ◽  
Cognitive Behavioural ◽  
Graded Exercise Therapy ◽  
Graded Exercise

Cognitive behavioural therapy and graded exercise therapy are promoted as evidence-based treatments for myalgic encephalomyelitis/chronic fatigue syndrome. This article explores patients’ symptom responses following these treatments versus pacing therapy, an approach favoured by many sufferers. We analyse data from a large cross-sectional patient survey ( n = 1428) and compare our findings with those from comparable patient surveys ( n = 16,665), using a mix of descriptive statistics and regression analysis modelling. Findings from analysis of primary and secondary surveys suggest that cognitive behavioural therapy is of benefit to a small percentage of patients (8%–35%), graded exercise therapy brings about large negative responses in patients (54%–74%), while pacing is the most favoured treatment with the lowest negative response rate and the highest reported benefit (44%–82%).

Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial

2013 ◽  
Vol 44 (7) ◽  
pp. 1545-1552 ◽  
Author(s):  
J. H. Bourke ◽  
A. L. Johnson ◽  
M. Sharpe ◽  
T. Chalder ◽  
P. D. White
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Muscle Pain ◽  
Joint Pain ◽  
Pain Treatment ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Common Symptom ◽  
Fatigue Syndrome ◽  
Graded Exercise Therapy ◽  
Pain Outcomes

BackgroundPain is a common symptom of chronic fatigue syndrome (CFS). We investigated the effects of the treatments used in the PACE trial [cognitive behavioural therapy (CBT), graded exercise therapy (GET), adaptive pacing therapy (APT) and specialist medical care (SMC)] on pain in CFS.MethodWe compared pain outcomes including individual painful symptoms, taken from the CDC criteria for CFS and co-morbid fibromyalgia. We modelled outcomes adjusting for baseline variables with multiple linear regression.ResultsSignificantly less frequent muscle pain was reported by patients following treatment with CBT compared to SMC (mean difference = 0.38 unit change in frequency, p = 0.02), GET versus SMC (0.42, p = 0.01) and GET versus APT (0.37, p = 0.01). Significantly less joint pain was reported following CBT versus APT (0.35, p = 0.02) and GET versus APT (0.36, p = 0.02). Co-morbid fibromyalgia was less frequent following GET versus SMC (0.03, p = 0.03). The effect sizes of these differences varied between 0.25 and 0.31 for muscle pain and 0.24 and 0.26 for joint pain. Treatment effects on pain were independent of ‘change in fatigue’.ConclusionsCBT and GET were more effective in reducing the frequency of both muscle and joint pain than APT and SMC. When compared to SMC, GET also reduced the frequency of co-morbid fibromyalgia; the size of this effect on pain was small.

scholarly journals Investigating the effectiveness and cost-effectiveness of FITNET-NHS (Fatigue In Teenagers on the interNET in the NHS) compared to activity management to treat paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): amendment to the published protocol

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Emma Anderson ◽  
Daisy Gaunt ◽  
Chris Metcalfe ◽  
Manmita Rai ◽  
William Hollingworth ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cost Effective ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
The Internet ◽  
Trial Protocol ◽  
Fatigue Syndrome ◽  
Therapy Program ◽  
Cognitive Behavioural ◽  
Activity Management

Abstract The FITNET-NHS Trial is a UK, national, trial investigating whether an online cognitive behavioural therapy program (FITNET-NHS) for treating chronic fatigue syndrome/ME in adolescents is clinically effective and cost-effective in the NHS. At the time of writing (September 2019), the trial was recruiting participants. This article presents an update to the planned sample size and data collection duration previously published within the trial protocol. Trial registration ISRCTN, ID: 18020851. Registered 8 April 2016.

scholarly journals What treatments work for anxiety in children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)? Systematic review

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e015481 ◽  
Author(s):  
Sarah Victoria Ellen Stoll ◽  
Esther Crawley ◽  
Victoria Richards ◽  
Nishita Lal ◽  
Amberly Brigden ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Fatigue Syndrome ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Myalgic Encephalomyelitis ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Fatigue Syndrome ◽  
Diagnostic Status ◽  
Randomised Controlled

ObjectivesAnxiety is more prevalent in children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) than in the general population. A systematic review was carried out to identify which treatment methods are most effective for children with CFS and anxiety.DesignSystematic review using search terms entered into the Cochrane library and Ovid to search the databases Medline, Embase and psychINFO.ParticipantsStudies were selected if participants were <18 years old, diagnosed with CFS/ME (using US Centers for Disease Control and Prevention, the National Institute for Health and Care Excellence or Oxford criteria) and had a valid assessment of anxiety.InterventionsWe included observational studies and randomised controlled trials.ComparisonAny or none.OutcomesChange in anxiety diagnostic status and/or change in anxiety severity on a validated measure of anxiety from pretreatment to post-treatment.ResultsThe review identified nine papers from eight studies that met the inclusion criteria. None of the studies specifically targeted anxiety but six studies tested an intervention and measured anxiety as a secondary outcome. Of these studies, four used a cognitive behavioural therapy (CBT)-type approach to treat CFS/ME, one used a behavioural approach and one compared a drug treatment, gammaglobulin with a placebo. Three of the CBT-type studies described an improvement in anxiety as did the trial of gammaglobulin. As none of the studies stratified outcomes according to anxiety diagnostic status or severity, we were unable to determine whether anxiety changed prognosis or whether treatments were equally effective in those with comorbid anxiety compared with those without.ConclusionWe do not know what treatment should be offered for children with both anxiety and CFS/ME. Further research is therefore required to answer this question.Trial registration numberThis review was registered on Prospective Register of Systematic Review Protocols (PROSPERO) and the protocol is available fromhttp://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016043488.

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