British Medical Journal: Letters: Many questions remain about treatments for CFS

April 9, 2009

The following letter from Tom Kindlon appears in the print edition of the British Medical Journal this week. Mr Kindlon is information officer for the Irish ME/CFS Association.

Many questions remain about treatments for CFS

Tom P Kindlon

BMJ 2009;338 b1371

Published 7 April 2009, doi:10.1136/bmj.b1371

Cite this as: BMJ 2009;338:b1371


Chronic fatigue syndrome

Many questions remain about treatments for CFS

After the unsuccessful High Court challenge to the NICE guidelines on chronic fatigue syndrome (CFS),1 the results of two recent reviews may temper many clinicians' enthusiasm for cognitive behavioural therapy for

CFS.2 3

A meta-analysis by Malouff et al calculated the mean Cohen's d effect size of cognitive behavioural therapy for CFS to be 0.48.2 This is below the 0.5 threshold generally required for a treatment to be seen as having a

"moderate" effect.

A 2008 Cochrane review analysed the data in another way and found that 40% of patients reported improvements in fatigue after cognitive behavioural therapy compared with 26% in usual care at the end of treatment. At follow-up, 1-7 months after treatment ended, when people who had dropped out

were included, there was no significant difference between the two groups.

Given that CFS is recognised as being heterogeneous by researchers,4 it remains far from clear that the NICE guidelines will be suitable for all.

The systematic review on which the guidance was largely based found that several other treatment methods, both behavioural and pharmaceutical, showed some promise in controlled studies but could not be recommended without more research.5 When more randomised controlled trials have been performed, evidence based guidelines may look very different.

Cite this as: BMJ 2009;338:b1371

Tom P Kindlon, information officer (voluntary position)1

1 Irish ME/CFS Association, Dublin, Republic of Ireland

Competing interests: None declared.


Dyer C. High court rejects challenge to NICE guidelines on chronic fatigue syndrome. BMJ 2009;338:b1110. (18 March.)[Free Full Text]

Malouff JM, Thorsteinsson EB, Rooke SE, Bhullar N, Schutte NS. Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis. Clin Psychol Rev 2008;28:736-45.[CrossRef][ISI][Medline]

Price JR, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev 2008 Jul 16;(3):CD001027.

Jason LA, Corradi K, Torres-Harding S, Taylor RR, King C. Chronic fatigue syndrome: the need for subtypes. Neuropsychol Rev 2005;15:29-58.[CrossRef][ISI][Medline]

Chambers D, Bagnall AM, Hempel S, Forbes C. Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. J R Soc

Med 2006;99:506-20.[Abstract/Free Full Text]

Link to BMJ article 

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