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Treatments For Chronic
Fatigue Show
Mixed Results


NEW YORK (Reuters Health) - Exercise therapy and a type of behavioral therapy show promise for relieving the symptoms of chronic fatigue syndrome, according to a review of clinical trials of patients with the illness.

Still, researchers say it is difficult to draw firm conclusions about therapies for chronic fatigue syndrome, or CFS, since the evidence is very limited.

Chronic fatigue syndrome is characterized by a range of symptoms including fatigue, headache, sleep problems, muscle pain and difficulty concentrating. CFS often strikes suddenly and may be accompanied by a low-grade fever and swollen lymph nodes. The cause is unknown, and there is no laboratory test that can diagnose the illness.

Besides the difficulty of diagnosing CFS, deciding how to treat the illness is complicated as well. With no known underlying cause, most of the therapies given to CFS patients target only symptoms, such as muscle pain and fatigue. The scientific evidence on the effectiveness of various treatments has been mixed.

To determine the state of the current evidence, two teams of researchers--one at the University of York in England and another at the University of Texas at San Antonio--reviewed 44 trials of CFS therapies. All of the studies included a ''control'' group of patients who did not receive the treatment being evaluated.

According to the University of York's Penny Whiting, the review indicated that the research on CFS treatment is limited. She told Reuters Health that weaknesses in the way the studies were performed make it difficult to apply the findings to wider groups of patients.

In addition, Whiting and her colleagues conclude that the criteria for including patients in the studies, which sometimes excluded the most severely ill patients, also limit the applicability of the results.

``Overall, the interventions demonstrated mixed results in terms of effectiveness,'' the authors write in the September 19th issue of The Journal of the American Medical Association. ''All conclusions about effectiveness should be considered together with the methodological inadequacies of the studies.''

However, some forms of behavioral therapy and exercise therapy seem to provide benefits to some people with CFS. Treatment with immunoglobulin, an immune-system protein, and hydrocortisone, which fights inflammation, also provided limited benefits. But the evidence on both therapies is still inconclusive, according to Whiting and her colleagues.

Based on the review, the researchers conclude that there is too little evidence to evaluate the effectiveness of several types of drugs, supplements and alternative treatments such as massage therapy.

In an accompanying editorial, Dr. Simon Wessely of Guy's King and St. Thomas' School of Medicine in London expresses concern that the results of the review may get lost in the ongoing controversy about CFS.

Ideally, CFS patients and the physicians who treat them would respond to the report by working to standardize the study of CFS therapies, according to Wessely. He notes that there might also be a push to increase funding for the types of treatment that appear most promising.

But given the controversy surrounding CFS, the response to the report is unlikely to be unified, Wessely points out. He predicts that some people will attempt to refute the findings of the review and that others will see the effectiveness of behavioral therapy as proof that CFS patients are mentally unstable.

``For progress to occur,'' Wessely writes, ``what is needed is not more polemics, but a rapprochement and increased cooperation between physicians and patient groups.''

SOURCE: The Journal of the American Medical Association 2001;286:1360-


Reference Source 89

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