UK BACME ME/CFS Guide to Therapy 2025

I guess they think the guff makes sense because their entire training is based on guff.
Makes sense to me.
But there is also a huge amount of politically correct justification that is clearly a response to a perception that this is what is needed to justify what they do and their salaries
That’s a good point. The rehab as a human right argument fits this bill.

I also just realised that there is not a single source about the approach. Probably because it doesn’t exist, but that should be a massive res flag for any reader. It’s as little evidence based as it’s possible to be.
 
On page 29, in 'Section 4: Sustaining' ('To continue a focus on the person’s goals and an improved quality of life, whilst accommodating the demands of daily life over time') there's a subsection titled 'Emotional wellbeing', and the first bullet point under it is 'Self-management of grading'. Anyone know what that means? There's no explanation, and no other occurrence of 'grading' in the document.
 
ust to let people know that there is some discussion among forum staff/committee about what action we might take. Some document drafting in very early stages. We'll let you know when we are clearer about what we might do.

I think a response is needed. Copies should go to the charities and if possible to the DHSC lead for the delivery plan.

My main thoughts would be:

1. No reliable evidence base is provided for recommendations and as far as we know there is none.
2. Many of the sections consist entirely of politically correct platitudes without information content.
3. The biological information given is baseless and confused.
4. The justification for a rehabilitative approach delivered by a team of therapists is not given and as far as we know there is none. As a physician fully accredited in rehabilitation medicine I cannot see anything in the document of value to patients and a lot that appears misleading.
5. The document notes the need for regular long-term review but fails to point out that this is not provided by an interdisciplinary rehabilitation course. It requires long-term physician follow-up.
 
Just ran this by my (MD) wife as she was headed out to a shift at the ER:

Me: Hey babe, remember GET?

Her: *Groans* Uhgh. Yeah?

Me: Well they’re calling it “Pacing up” now.

Her: Lipstick on a pig.


You all hit the nail on its head. And this definitely deserves concerted pushback.

Tell me WHY exercise makes me ill whereas it used to make me strong. Then we can talk. Not before. Not until.
 
What is the laboratory proof of a theoretically devastating dysregulation? My clinical tests are normal are they not?

I have quite enough on my plate with grievous bodily harm done by disease interfering with biochemistry and signal transmission.

My homeostasis is so strong it holds to a pattern albeit a pattern warped and shifted by disease. My homeostasis still optimises its patterning for my survival. It is not optimum, but it is optimal.

And it is my internal niche.

Who dares tell me their informant assumed I must be - maybe - dysregulated. If I was dysregulated I'd be dead. Do not interfere with my homeostasis. The invasion could even dysregulate me.
 
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Just ran this by my (MD) wife as she was headed out to a shift at the ER:

Me: Hey babe, remember GET?

Her: *Groans* Uhgh. Yeah?

Me: Well they’re calling it “Pacing up” now.

Her: Lipstick on a pig.


You all hit the nail on its head. And this definitely deserves concerted pushback.

Tell me WHY exercise makes me ill whereas it used to make me strong. Then we can talk. Not before. Not until.
That’s the kind of response we all deserve from our loved ones. She’s a gem!
 
I think a response is needed. Copies should go to the charities and if possible to the DHSC lead for the delivery plan.

My main thoughts would be:

1. No reliable evidence base is provided for recommendations and as far as we know there is none.
2. Many of the sections consist entirely of politically correct platitudes without information content.
3. The biological information given is baseless and confused.
4. The justification for a rehabilitative approach delivered by a team of therapists is not given and as far as we know there is none. As a physician fully accredited in rehabilitation medicine I cannot see anything in the document of value to patients and a lot that appears misleading.
5. The document notes the need for regular long-term review but fails to point out that this is not provided by an interdisciplinary rehabilitation course. It requires long-term physician follow-up.
Should it also be pointed out that the document never explains the rationale for why doing more would result in an improvement?

There’s not even an underlying theory here because they’ve ditched the deconditioning and unhelpful beliefs model that was the reasoning of pacing up originally. It just says that pacing up will help because BACME thinks it will help.
 
There is so much misrepresentation. I want to tell the local commissioners (clinical, municipal and police) it is mis-selling (so they need to tell their respective Safeguarding Leads).

Pacing does NOT "improve functional capacity", it preserves my capability and precludes unnecessary exertion.

I obviously have no spare capacity for exercise programs, let alone for any interface to tailor exercise, and then evaluate it.

All of my effort-capacity is pre-occupied, as its not even sufficient for essential chores and comms, and so the notion is preposterous, its all been a very big misunderstanding.
 
I think a response is needed. Copies should go to the charities and if possible to the DHSC lead for the delivery plan.

My main thoughts would be:

1. No reliable evidence base is provided for recommendations and as far as we know there is none.
2. Many of the sections consist entirely of politically correct platitudes without information content.
3. The biological information given is baseless and confused.
4. The justification for a rehabilitative approach delivered by a team of therapists is not given and as far as we know there is none. As a physician fully accredited in rehabilitation medicine I cannot see anything in the document of value to patients and a lot that appears misleading.
5. The document notes the need for regular long-term review but fails to point out that this is not provided by an interdisciplinary rehabilitation course. It requires long-term physician follow-up.
Thank you, that is helpful. Those are the points I would expect to include. I expect we will want to do some consultation with you and others at some stage.
 
I wonder if it’s intentional that they write guff or if they actually believe the guff makes sense?

I’ve only encountered this level of guff in business when it’s very clear that the person in charge really does not care about the quality. So it’s often a case of not prioritising it, not a lack of ability per se.
It’s giving “we brought in a management consultancy to write a report on staff engagement”.
 
My three ha'porth:

If a person with ME/CFS takes up the offer of a personalised physical activity or exercise programme, agree a programme with them that involves the following and review it regularly:
  1. establishing their physical activity baseline at a level that does not worsen their symptoms
  2. initially reducing physical activity to be below their baseline level
  3. maintaining this successfully for a period of time before attempting to increase it
  4. making flexible adjustments to their physical activity (up or down as needed)
  5. to help them gradually improve their physical abilities while staying within their energy limits
  6. recognising a flare-up or relapse early and outlining how to manage it.

    [Original bullet points replaced with numbers by me]

1. Authors appear unaware that cognitive activity and sensory load contribute as much to symptom worsening as physical activity.
2. Authors do not understand that this is unfeasible, as ordinary daily living tasks exceed the baseline.
3. See 2.
4. See 2.
5. Authors do not provide any evidence this works.
6. Authors appear unaware that people with ME/CFS cannot know whether their constantly shifting PEM threshold has been crossed until after the event.
 
Always this tap-dance around 'flexibility' and 'as needed' (as decided by whom?) and 'likely to be successful but...', and putting the responsibility on the patient to know whether they're doing too much or not enough, but at the same time telling them they're not actually competent to decide for themselves so they need 'support to increase confidence' etc. All to disguise the fact that none of this is based on anything solid.
And blaming the patient when it doesn't work, and worse.
I think the PEM concept has been deliberately distorted in order that it can be misused.
Wildly misused, just like pacing.
There is no indication whatever as to why there should be a need for a therapy team. One well-informed person could advise a patient in much more detail than given in this document.
Exactly. It is just a highly intrusive invasive power grab over our lives, with zero justification, and highly adverse consequences for us. Whatever legitimate practical advice could be currently offered could easily fit on a single page. Mostly consisting of listen to your body, and try to avoid exacerbating symptoms.
2. Authors do not understand that this is unfeasible, as ordinary daily living tasks exceed the baseline.
I wish I could get the pros to understand this.

Plus I also think the whole 'baseline' concept is a disaster. If anything it is more like a ceiling. But I can see them also misappropriating that and twisting it to their purposes without any underlying change to their beliefs and practices.
 
For various reasons we’ve always had to waste our energy assuming or giving good grace that intentions are good or that what someone does and how they act to us somehow isn’t exactly an indicator of what they want for us.

But I’ve got to the point now where I feel like I need to wear a body cam if I interact with these type of people and record all conversations.

Because I’ll be frank whether they are the ones writing it to cause it by others or doing it then using this to claim that what I’m not getting the vibes back they are secretly proud of as eg departments instead of ashamed: harming us and we for some reason assume that isn’t the aim of these groups to play their part in this big chain if blocking access and watching a human being get crumbled , merely because we aren’t ourselves evil people and are too kind to these individuals within this system.

I’ve engaged with good grace with certain types and got what I should have just realised was obvious whiff of nasty bigot but assumed they are just confused when really all these documents are is instructions manuals for these groups of people to continue doing the same - and I’ve never experienced malign, irrationally driven behaviour like it - but to cover it up more as ‘policy’ so that on top of being harmed we get accused as paranoid fibbers if we even gently suggest what they are doing isn’t ’being Good people trying to help’.

But they aren’t and I’ve tried open-mindedly with support going thru the rational processes for basic things with these people and they are just playing nasty games where they do indeed see exactly how ill and collapsing I am. and there is normally one person there who has been dragged along, perhaps more junior for that meeting, clearly told laugh at us nonsense about us before the meeting and then within minutes realises they have been stitched up by who they are accompanying and their boss to be a henchman and the person in front of them is actually ill and legitimate and I see their awkwardness or they’ve been asked to do something watch the consequences then spend the rest of the time profusely apologising whilst the other carries on as intended, hard to it all.

So whilst I’m being gaslighted by most around me including many who think themselves advocates in some way I’ve luckily had enough people with me this time who have at least been honest on what they’ve seen or found when they interacted so I know it isn’t just me, like those other people in or adjacent to the system want to kid themselves. I get one bunch trying to pretend no, no it’s not that they have bad intentions or have decided it’s no from the start and then guff pretending the strange pattern of deliberate cherry-picking , misinterpretation and predatory leading questions is somehow my confusion still trying to force me to say that’s not what is going on.

And it’s at the point of driving me insane because that’s despite 25yrs flags and me being over nice trying to think how those flags could just be normal confusion or someone in a rush when that becomes more of a stretch. But it’s my responsibility to do that for me to not get in trouble to somehow cover up for them , the bad ones, even when they need calling out and just need to act normal to speed things up and make it make sense.

They aren’t following normal process but inventing new questions for example, writing reports without having asked the questions of the person first then refusing to change it but using those to steal more information from people when they have to line by line refute the made-up fabricated lies.

I can’t believe how serious the problem is on the ground with those who are ‘in it’. It’s upset their colleagues who didn’t realise what they’ve seen were getting dragged into bullying level. And I knew from all the years how bad the bigotry on the ground is.

I’d suggest this is a potentially a document whose purpose is merely to legally justify or provide cover for the extreme harm some are doing in a joined up way already anyway. Behaviour they don’t want to change and do reacted to the last 4-5yrs simply with no intention to change and in fact ramping up their anger at having been called out by the guideline and taking it out on the most vulnerable of pwme in retaliation

And when I go back to the White,sharpe, Chalder article from Dec 2021 published (with a version written in oct 2021 and published on the kings website) I’d be interested to see if the same message of

‘what should be enacted upon us’ is any different at all .

But I think the ‘guff’ is deliberate long ramble so that no one will read it, no one can prove it doesn’t square any of its circles or non sequiturs. The point is for no one to understand and for it to grammatically not add up so that most assume they can’t understand it not due to this deficiency in the writer or ideology but themselves ‘not getting it because they aren’t experts’ . It’s intended to intimidate by being unreadable.

It no longer matters whether its deliberate because they are deluded and think for some reason they aren't immoral and harmful, just selfish, or if it is plain malign - but people need to begin stopping hurting us by insisting that whilst it is by this stage one or the other that we have to stick with the one illusion that the behaviour doesn't add up to which is that it is neither. We don't have to say either out loud, but we absolutely do have to stop harming pwme by insisting that underlying (maybe unconscious, maybe they are so deluded they don't realise they've been brainwashed into harm and tropey beliefs is exactly this) issue must be danced around and what is going on isn't really - because it makes us look mad. When it all adds up as soon as we all acknowledge what has always been known which is this grim discriminatory and refuse to correct ideas that are all to do with personality ideas that don't add up and were never to do with our health but just slighting us. And no they aren't 'rising above' in dealing with us, but being the opposite of 'holistic' by treating us with a 'talk to the hand, yer mad' attitude.

Because that is causing huge harm. Imagine being on the receiving end of trickery behaviour when you are as ill as we are and then having to dance around it 'making sense' because, whilst it makes utter sense when we all admit what is the plain case and makes it all add up, we all have to pretend. And worse it happens to be the source and cause of both the problem and without solving it and calling it and monitoring it to ensure it changes makes it impossible that the problem can be solved or that anything can change.
 
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I think trying to argue that this is not NICE compliant is likely to end up boxed in a corner.
NICE fudged this. The wording provided allows almost anything.

I think this should be resisted on the much simpler argument that there is no reliable evidence base for it. If this policy had been considered systematically by NICE alongside GET and CBT it would have been thrown out as unevidenced. There aren't even any trials.

I think we should forget NICE compliance. The charities need to be challenged on their position in terms of absence of reliable evidence.
Yup. A good biomarker would render a lot of this BacME ableist-waffle entirely redunda.
 
On page 29, in 'Section 4: Sustaining' ('To continue a focus on the person’s goals and an improved quality of life, whilst accommodating the demands of daily life over time') there's a subsection titled 'Emotional wellbeing', and the first bullet point under it is 'Self-management of grading'. Anyone know what that means? There's no explanation, and no other occurrence of 'grading' in the document.

Internet search for 'grading in therapy' finds lots of explanations like this one:

In occupational therapy, a reference of my old lecture notes defines gradation (Reed and Sanderson, 1990) as an intervention technique that categorizes tasks into degrees of difficulty or complexity.

In the simplest of terms, gradation, or “grading” increasing or decreasing the difficulty of an intervention based on how the client responds or performs.

Purpose of Gradation

  • To select an activity that is at the client’s functional ability (otherwise they will get discouraged or give up; too easy and they get bored and are not fully engaged).
  • To meet the client’s needs.
  • To promote client success.
  • Engagement in meaningful occupations.
from https://www.otdude.com/students/introduction-to-grading-occupational-therapy-interventions/

So it's just the same assumption again: what pwME need is to be continually challenged to 'progress' by doing more, just at the 'right' pace. Not Graded Exercise Therapy but still graded activity therapy. And this is apparently the first point to consider for 'Emotional wellbeing'.
 
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It just struck me that I don’t think there is any deliberation about the pros and cons of risking triggering PEM. They seems to have decided that PEM can’t be dangerous, only temporarily unpleasant.

We don’t have causal evidence that PEM is dangerous, but there are so many anecdotes of deterioration and the list of adverse events in e.g. MAGENTA is so long that any oath to do no harm should be triggered a long time ago.

They argue that the push crash cycles is what makes people worse, but never explain how. In the deconditioning model it was because of excessive rest, and in the unhelpful thoughts model is was because of reinforced behavioural patterns. In the functional model it’s because of neuroplasticity.

The closest they come is the mention of the dysregulation model, but that just says that some things are out of whack and the body isn’t able to get them back in order as quickly as you’d like. But if you give it time, it will sort itself out.

But if that’s the case, then trying to do more and risking PEM would be counterproductive.
 
So it's just the same assumption again: what pwME need is to be continually challenged to 'progress' by doing more, just at the 'right' pace.

Yup. The concept of getting fitter, which works great when you're well enough to do it.

People are advised to rest when they have a virus, because carrying on with their training achieves nothing from a fitness point of view and will probably make them feel terrible. ME/CFS needs to be thought of like an acute illness because it behaves like one.

[Slight edit for clarity]
 
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