Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome, 2017, Castro-Marrero et al.

[Suffolkres]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301046/

Reads rather well

 

[Trish]

Abstract
This review explores the current evidence on benefits and harms of therapeutic interventions in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and makes recommendations.

CFS/ME is a complex, multi‐system, chronic medical condition whose pathophysiology remains unknown. No established diagnostic tests exist nor are any FDA‐approved drugs available for treatment. Because of the range of symptoms of CFS/ME, treatment approaches vary widely. Studies undertaken have heterogeneous designs and are limited by sample size, length of follow‐up, applicability and methodological quality.

The use of rintatolimod and rituximab as well as counselling, behavioural and rehabilitation therapy programs may be of benefit for CFS/ME, but the evidence of their effectiveness is still limited. Similarly, adaptive pacing appears to offer some benefits, but the results are debatable: so is the use of nutritional supplements, which may be of value to CFS/ME patients with biochemically proven deficiencies.

To summarize, the recommended treatment strategies should include proper administration of nutritional supplements in CFS/ME patients with demonstrated deficiencies and personalized pacing programs to relieve symptoms and improve performance of daily activities, but a larger randomized controlled trial (RCT) evaluation is required to confirm these preliminary observations.

At present, no firm conclusions can be drawn because the few RCTs undertaken to date have been small‐scale, with a high risk of bias, and have used different case definitions. Further, RCTs are now urgently needed with rigorous experimental designs and appropriate data analysis, focusing particularly on the comparison of outcomes measures according to clinical presentation, patient characteristics, case criteria and degree of disability (i.e. severely ill ME cases or bedridden).

 

[Jonathan Edwards]

I am afraid from this is a Morecambe/Previn muddle to me - all the right notes but not necessarily in the right order. I keep thinking I am not going to be further surprised by how poor journal editing is but it saddens me that the British Journal of Pharmacology should print something so meandering and full of not quite right statements.

We need more than researchers to have their hearts in the right place. We need them to know what they are doing.

 

[Suffolkres]

I am afraid from this is a Morecambe/Previn muddle to me - all the right notes but not necessarily in the right order. I keep thinking I am not going to be further surprised by how poor journal editing is but it saddens me that the British Journal of Pharmacology should print something so meandering and full of not quite right statements.

We need more than researchers to have their hearts in the right place. We need them to know what they are doing.

It's clear I should have read this in more detail!.........

 

[Hutan]

I agree with Jonathan, it's a muddle. The assessment of ME/CFS treatment trials is very inadequate - the authors needed to have a lot more skepticism. Statements contradict each other, and together all add up to an approach that is very vague, and could support anything so long as it is 'personalised and integrated'.

In summary, nutritional supplementation is recommended in CFS/ME patients with biochemically proven deficiencies. CFS/ME treatment should also be optimized by the use of individualized pacing strategies, customization of CBT and other types of counselling and behavioural therapies so as to help relieve the symptoms. GET should be carefully modulated by an individual pacing strategy using strict case definitions to avoid the push‐crash cycle.

Most clinicians agree that CFS/ME patients need a treatment based on a personalized multidisciplinary and integrative medicine approach. The most disruptive symptoms should be addressed first. In general, the therapy will combine psychological counselling and mild, guided exercise. CBT seems to work well with paediatric CFS/ME patients

Children have been successfully treated using antidepressants and therapy

Even in the absence of clinical nutritional deficiencies, the physiological demands of a chronic illness make it necessary to provide additional nutritional support

Graded exercise works best for CFS/ME when combined with CBT and psychoeducation therapy, but it may not work for all CFS/ME patients. In fact, over‐exercising may intensify symptoms, and some patients experience profound fatigue after even moderate exercise.

Between 50–55% of CFS patients versus 24% of controls reported that they felt much better after the 12 weeks of exercise therapy. Furthermore, around 40% of patients in this study had a probable comorbid anxiety or depression, suggesting that graded exercise could be more effective in these patients.