Unity of opposites? Chronic fatigue syndrome and the challenge of divergent perspectives in guideline development

Successful Psychological Strategies of Experienced Chronic Fatigue Patients: A Qualitative Study

Trying to care for patients with medically unexplained symptoms (MUS) can lead to frustration and disappointment for both patients and health care professionals alike. Learning positive ways to assist patients avoids professionals collapsing into therapeutic nihilism. We sought to understand how people with such symptoms can live well despite (or even because of) their condition. Chronic fatigue was chosen as the exemplar symptom. Participants were invited to join the research if they, themselves, considered they were living well with this symptom. One-on-one interviews using an appreciative enquiry approach were performed and thematic analysis undertaken. Twelve participants were interviewed before data saturation occurred. The emotional stance or relationship a participant had with, and towards, their illness was the primary determinant underlying their interpretation of “living well.” Five major themes of this meta-theme were identified: (1) engaging with elusiveness, (2) befriending uncertainty, (3) reflecting on self, (4) living creatively, and (5) moving in stillness. Encouraging patients who are struggling with MUS to consider how they emotionally engage with their illness via these 5 positive dynamics may lead to better health outcomes for patients and happier, more fulfilled health care professionals.

A UK based review of recommendations regarding the management of chronic fatigue syndrome

OBJECTIVES

Chronic fatigue syndrome (CFS) is a controversial illness, with apparent disagreements between medical authorities and patient support organisations regarding safe and effective treatments. The aim of this study was to measure the extent of different views regarding treatments, comparing patient support organisations and medical authorities in the UK.

METHODS

Two independent raters analysed two groups of resources: UK patient support websites and both medical websites and textbooks. A 5-point Likert scale was developed with the question 'With what strength does the source recommend these treatments?' The various treatments were divided into the following four groups: complementary and alternative medicine (CAM), pharmacological, rehabilitative, and pacing therapies.

RESULTS

There were significant differences between the scores for patient support organisations and medical sources for all 4 treatment groups. The results for supporting CAM were 74% (patient group) vs 16% (medical source) (p<0.001), 71% vs 42% for pharmacological (p=0.01), 28% vs 94% for rehabilitative (p<0.001) and 91% vs 50% for pacing treatments (p=0.001).

CONCLUSIONS

There were substantially different treatment recommendations between patient support organisations and medical sources. Since expectations can determine response to treatment, these different views may reduce the engagement in and effectiveness of rehabilitative therapies recommended by national guidelines and supported by systematic reviews.

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

The 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.

Contrasting Chronic Fatigue Syndrome versus Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

BACKGROUND

Much debate is transpiring regarding whether chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) are different illnesses. Several prior studies that compared the Fukuda et al. CFS criteria to the Canadian ME/CFS criteria found that the Canadian criteria identified patients with more functional impairments and greater physical, mental, and cognitive problems than those who met Fukuda et al. criteria.[3,4] These samples were located in the Chicago metropolitan area, so the results could not be generalized to other locations. In addition, past studies used a symptom questionnaire that was not specifically developed to tap the Canadian criteria.

PURPOSE

The present comparative study of CFS and ME/CFS criteria was intended to correct the methodological problems of prior studies.

METHODS

This article used data from three distinct samples to compare patients who met criteria for the ME/CFS Canadian clinical case definition [1] to those who met the Fukuda et al. CFS case definition.[2].

RESULTS

Findings indicated that fewer individuals met the Canadian criteria than the Fukuda et al. criteria. Those who met the Canadian criteria evidenced more severe symptoms and physical functioning impairment.

CONCLUSIONS

Future research should continue to compare existing case definitions and determine which criteria best select for this illness.