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Rethinking The Standard Of Care For ME/CFS

Friday 25 October 2019


From the Journal of General Internal Medicine:



Rethinking the Standard of Care for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Fred Friedberg, Madison Sunnquist, Luis Nacul
First Online: 21 October 2019
© 2019 Springer Nature Switzerland AG. Part of Springer Nature.

Cite this article as: Friedberg, F., Sunnquist, M. & Nacul, L. J GEN INTERN MED (2019).

For over two decades, the standard of care for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has been cognitive behavior therapy (CBT) and graded exercise therapy (GET). Both interventions had been recommended by the US Centers for Disease Control and the UK NICE guidelines.1 Behavioral intervention as the clinical standard was given a considerable boost by the 5 million–pound PACE trial, a large multi-arm randomized trial of CBT and GET launched in 2007.2 This British government–funded trial was intended to definitively answer whether such interventions were beneficial in ME/CFS. In their 2011 and 2013 publications, the PACE trial authors announced with widespread publicity that 22% of their patients had “recovered” and 59–61% had clinically improved across the CBT and GET interventions.2, 3

More generally, multiple literature reviews have reported that these therapies are not only effective at improving fatigue and, to a lesser extent, physical function in ME/CFS but also safe.4, 5, 6 It would seem obvious then that good clinical care of these patients would include these behavioral interventions. But, a closer look at these trials has generated many concerns about their applicability to these patients. This perspective critically examines their findings and more generally discusses the behavioral intervention literature in ME/CFS. Finally, we briefly describe a pragmatic clinical approach for these often-marginalized patients.


Full article…



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