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Treatments
For Chronic
Fatigue Show
Mixed Results
Excerpt By Merritt McKinney, Reuters
Health
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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