BackgroundChronic fatigue syndrome (CFS)/ myalgic encephalopathy (ME), has attracted considerable attention in recent decades in the media, research world and clinical practice. Cognitive behavior therapy (CBT) and graded exercise therapy (GET) have been most intensively studied, but there are still a lot of unanswered questions about the treatment of CFS/ME.
ObjectiveThe aim is to study the effect of GET, pacing and CBT on CFS/ME patients in all ages.
MethodsA systematic literature search of randomized controlled trials was carried out using Cochrane Library, PubMed and PsycINFO. The search was limited to last 5 years.
ResultsCBT and GET are still the only interventions found to be effective in the treatment of CFS/ME patients. CBT given as group therapy, individual therapy or guided self-instruction can be effective for adults when it comes to fatigue, functional disability in all domains, illness perception, clinical global impression and clinically significant improvement. The effect on physical functioning and depressive symptoms is however insecure, and there is no documented effect on cognitive deficits and quality of life. The treatment effect is less than the half for patients with more severe CFS (SIP8 > 1 SD over mean), and those patients therefore should be referred directly to a specialist in CBT. However it is uncertain whether individual CBT gives better results than group CBT. The effect of CBT seems to increase even further with the addition of mirtazapine and the administration sequence seems to be of importance with the “12 weeks CBT followed by 12 weeks mirtazapine” as the best one. When it comes to adolescents, CBT after two protocols is effective treatment of fatigue, physical functioning, school attendance, some self-reported additional symptoms and clinically significant improvement. Several factors are thought to influence the treatment result, such as for example passive activity pattern, symptom focusing and type of diagnosis (CDC-1994 has worse prognosis than Oxford criteria), while others like treatment duration are less important. GET can be effective treatment for CFS patients having fatigue and clinical global improvement in mind, but it is insecure whether it improves physical functioning. The mechanism of improvement seems to be psychological in the form of reduced symptom focusing and increased ability to exert oneself rather than physiological.
ConclusionCBT and GET are still the only interventions found effective in the treatment of CFS/ME. Further research is however needed as not everyone recovers after either CBT or GET, there is lack of studies for the effect of GET on adolescents, and there is total lack of documentation for the sickest patients that cannot come to treatment. Standardization of diagnostic criteria and outcome measures is also needed.