Treatment
Treatment is largely supportive and focuses on symptom relief. Large randomized, controlled trials such as the pacing, graded activity, and cognitive behaviour therapy: a randomised evaluation (PACE) trial and reviews have recommended cognitive behavioral therapy (CBT) as an effective method for treating ME/CFS in adults. [19, 20] However, the surveillance report from the National Institute for Health and Care Excellence (NICE) recommends against CBT. [21] The Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ) both have removed CBT as a recommended treatment for ME/CFS because of insufficient evidence. [22]
Exercise is not a cure for ME/CFS. A review evaluated exercise therapy for patients with ME/CFS. The study found that patients felt less fatigued following exercise therapy and felt improved in terms of sleep, physical function, and general health. However, the authors could not conclude that exercise therapy improved the outcomes of pain, quality of life, anxiety, and/or depression. [23]
The PACE trial found that graded exercise therapy (GET) effectively improved measures of fatigue and physical functioning. [19] However, updates from the NICE guideline surveillance report recommend against GET. [19, 20, 21, 22]
Prognosis
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has no cure, its symptoms can persist for years, and its clinical course is punctuated by remissions and relapses. One prospective study suggests that approximately 50% of patients with ME/CFS can return to part-time or full-time work. [24] Longer duration of illness, severe fatigue, comorbid depression, and anxiety are factors associated with a poorer prognosis. [25] Good outcomes are associated with less fatigue severity at baseline, a sense of control over symptoms, and no attribution of the illness to a physical cause. [26] Despite the considerable burden of morbidity associated with ME/CFS, there is no evidence of an increased risk for mortality.
