PACE study results – story in ‘The Times’, 18 February 2011

From The Times, 18 February 2011 (story by health correspondent Chris Smyth).

ME sufferers ‘better pushing their limits’

Patients with ME, also known as chronic fatigue syndrome, who are encouraged to “test their limits” mentally and physically do better than those whose therapies help them to adapt to the condition, research suggests.

Talking therapy and exercise both proved more effective than treatments which “pace” the patient’s activity to their energy levels, a study in The Lancet concludes, with twice as many patients making a full recovery.

The study, based on the largest randomised trial of potential treatments, found that only a handful of patients worsened under any of the therapies.

ME (myalgic encephalomyelitis) affects about 250,000 people in Britain, leaving them severely lacking in energy. The cause of the condition remains unclear and evidence on effective treatments had been inconclusive.

Professor Trudie Chalder of King’s College London, a co-author of the study, said: “It is very encouraging that we have found not one but two treatments which are similarly helpful to patients, which provides them with a choice. We now need to find out what the common essential ingredient is that makes these treatments work, and which particular types of patients will respond best to which therapy.”

About 30 per cent of patients given cognitive behavioural therapy (CBT) or graded exercise made a full recovery to normal levels of activity, the study found, while 60 per cent made at least modest improvements. Of patients given pacing therapy, 15 per cent recovered, while 42 per cent made some improvement. These levels were almost identical in a control group.
Patients’ groups said the study did not reflect the results of surveys of sufferers. Sir Peter Spencer, chief executive of Action for ME, said people with ME who were polled rated pacing as the most effective, while a third said that graded exercise made them worse.

In 2009 a US study reported finding a virus in most of the ME sufferers it tested, raising hopes that a physical cause might be discovered. Follow-up studies failed to replicate the findings.
Professor Michael Sharpe of Edinburgh University, a co-author of the study, said the effectiveness of CBT did not necessarily imply a psychological cause. “People with cancer have psychological treatment but no one suggests that they are imagining their cancer,” he said.

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