Over a century ago Beard referred to fatigue as the ‘Central
Africa of medicine – an unexplored
territory which few men enter’ (Beard, 1869). The last decade has
seen major advances in our
understanding of chronic fatigue syndrome (CFS). Much is now known of the
epidemiology,
clinical features and prognosis of the condition (Wessely et al.
1998), and a number of recent papers
have reported randomized trials of successful treatments involving cognitive
behaviour therapy
(CBT) and graded exercise (Sharpe et al. 1996; Wearden et
al. 1996; Deale et al. 1997;
Fulcher & White, 1997). Despite these advances, which have defined
some of the broad landmarks
of the illness, and improved the care of patients, many areas remain uncharted.
Several papers
published in this issue of Psychological Medicine take us into
such unexplored territory.
Adaptive Pacing, Cognitive Behaviour Therapy, Graded Exercise, and Specialist Medical Care for Chronic Fatigue Syndrome: A Cost-Effectiveness Analysis