From BMC Health Services Research, 20 August 2012, (open-access).
Cost-effectiveness of counselling, graded-exercise and usual care for chronic fatigue: evidence from a randomised trial in primary care.
Sabes-Figuera R, McCrone P, Hurley M, King M, Donaldson AN, Ridsdale L.
Centre for the Economics of Mental and Physical Health (CEMPH), Institute of Psychiatry, King's College London, London, UK.
Abstract
BACKGROUND
Fatigue is common and has been shown to result in high economic costs to society. The aim of this study is to compare the cost-effectiveness of two active therapies, graded-exercise (GET) and counselling (COUN) with usual care plus a self-help booklet (BUC) for people presenting with chronic fatigue.
METHODS
A randomised controlled trial was conducted with participants consulting for fatigue of over three months’ duration recruited from 31 general practices in South East England and allocated to one of three arms. Outcomes and use of services were assessed at 6-month follow-up. The main outcome measure used in the economic evaluation was clinically significant improvements in fatigue, measured using the Chalder fatigue scale. Cost-effectiveness was assessed using the net-benefit approach and cost-effectiveness acceptability curves.
RESULTS
Full economic and outcome data at six months were available for 163 participants; GET = 51, COUN = 58 and BUC = 54. Those receiving the active therapies (GET and COUN) had more contacts with care professionals and therefore higher costs, these differences being statistically significant. COUN was more expensive and less effective than the other two therapies. The incremental cost-effectiveness ratio of GET compared to BUC was equal to £987 per unit of clinically significant improvement. However, there was much uncertainty around this result.
CONCLUSION
This study does not provide a clear recommendation about which therapeutic option to adopt, based on efficiency, for patients with chronic fatigue. It suggests that COUN is not cost-effective, but it
is unclear whether GET represents value for money compared to BUC.
From the Global Journal of Health Science, 12 December 2012.
Dyspnea in Chronic Fatigue Syndrome (CFS): Comparison of Two Prospective Cross-Sectional Studies.
Ravindran M, Adewuyi O, Zheng Y, Rayhan RU, Le U, Timbol C, Merck S, Esteitie R, Read C, Cooney M, Baraniuk J.
Georgetown University Medical Center.
Abstract
Chronic Fatigue Syndrome (CFS) subjects have many systemic complaints including shortness of breath. Dyspnea was compared in two CFS and control cohorts (Fukuda criteria agumented with severity scales) to characterize
pathophysiology.
Cohort 1 of 257 CFS and 456 control subjects were compared using the Medical Research Council chronic Dyspnea Scale (MRC Score; range 0-5).
Cohort 2 of 106 CFS and 90 controls answered a Dyspnea Severity Score (range 0-20) adapted from the MRC Score. Subsets of both cohorts completed CFS Severity Scores, fatigue, and other questionnaires.
A subset had pulmonary function and total lung capacity measurements.
Results show MRC Scores were equivalent between sexes in Cohort 1 CFS (1.92 [1.72-2.16]; mean [95% C.I.]) and controls (0.31 [0.23-0.39]; p<0.0001). Receiver-operator curves identified 2 as the threshold for positive MRC Scores in Cohort 1.
This indicated 54% of CFS, but only 3% of controls, had significant dyspnea.
In Cohort 2, Dyspnea Score threshold of 4 indicated shortness of breath in 67% of CFS and 23% of controls. Cohort 2 Dyspnea Scores were higher for CFS (7.80 [6.60-9.00]) than controls (2.40 [1.60-3.20]; p<0.0001).
CFS had significantly worse fatigue and other complaints compared to controls. Pulmonary function was normal in CFS, but Borg scores and sensations of chest pain and dizziness were significantly greater during testing than controls.
General linear model of Cohort 2 CFS responses linked Dyspnea with rapid heart rate, chest pain and dizziness.
In conclusion, sensory hypersensitivity without airflow limitation contributed to dyspnea in CFS. Correlates of dyspnea in controls were distinct from CFS suggesting different mechanisms.
The full study can be found here:
ccsenet.org/journal/index.php/gjhs/article/download/*222*40/14809
From Expert Opinion on Medical Diagnostics, 27 February 2013.
Editorial
Diagnosis of Myalgic Encephalomyelitis: where are we now?
Michael Maes (†1,2,3) MD PhD Professor, George Anderson(4), Gerwyn Morris(5) & Michael Berk(2,6,7,8)
(1) Chulalongkorn University, Department of Psychiatry, Bangkok, Thailand
(2) Deakin University, School of Medicine, Geelong, Australia
(3) PNI Clinics, Chiang Mai, Thailand
(4) CRC, Rm 30, Glasgow, Scotland
(5) Mumbles Head, Pembrey, llanelli
(6) Orygen Youth Health Research Centre, Centre for Youth Mental Health, Parkville, VIC, Australia
(7)The Flory Institute for Neuroscience and Mental Health, Parkville, VIC, Australia
(8) Melbourne University, Department of Psychiatry, Parkville, VIC, Australia
†Author for correspondence
INTRODUCTION
The World Health Organization has classified Myalgic Encephalomyelitis (ME) as a neurological disease since 1969 considering Chronic Fatigue Syndrome (CFS) as a synonym used interchangeably for ME since 1969. ME and CFS are considered to be neuro-immune disorders, characterized by specific symptom profiles and a neuro-immune pathophysiology. However, there is controversy as to which criteria should be used to classify patients with “Chronic Fatigue Syndrome.”
Areas covered: The Centers for Disease Control and Prevention (CDC) criteria consider chronic fatigue (CF) to be distinctive for CFS, whereas the International Consensus Criteria (ICC) stresses the presence of post-exertion malaise (PEM) as the hallmark feature of ME.
These case definitions have not been subjected to rigorous external validation methods, for example, pattern recognition analyses, instead being based on clinical insights and consensus.
EXPERT OPINION
Pattern recognition methods showed the existence of three qualitatively different categories: (a) CF, where CF evident, but not satisfying full CDC syndrome criteria. (b) CFS, satisfying CDC criteria but without PEM. (c) ME, where PEM is evident in CFS. Future research on this “chronic fatigue spectrum” should, therefore, use the abovementioned validated categories and novel tailored algorithms to classify patients into ME, CFS, or CF.
From Pain Management March 2013.
Case Report
α-1 antitrypsin and chronic fatigue syndrome: a case study from pathophysiology to clinical practice
José Alegre, Sandra Camprubí & Ana García-Quintana
Summary
BACKGROUND
Several lines of evidence support the involvement of inflammatory and immunologic abnormalities in chronic fatigue syndrome (CFS). Since recent studies have shown that α-1 antitrypsin (AAT) possesses anti-inflammatory properties, the potentialtherapeutic effect of AAT treatment on CFS has been investigated.
CASE PRESENTATION
A 49-year-old woman diagnosed with CFS was treated with intravenous infusions of a human plasma-derived AAT concentrate (60 mg/kg body weight weekly for 8 consecutive weeks). The patient’s monocyte elastase, a regulator of inflammatory processes, was 1170 U/mg. At completion of treatment, improvement in maximal workload was observed (54.0–71.7% of predicted).
Additionally, amelioration in working memory (scores: 83–94) and perceptual organization (scores:
75–83) were detected on the Wechsler Adult Intelligence Scale-III test. Monocyte elastase decreased to a normal range (<150 U/mg). Improvement in functional capacity allowed the patient to work in part-time employment.CONCLUSIONThese findings suggest a possible role for AAT in the treatment of CFS.
From the Journal of Psychiatric Research, 16 February 2013.
The prevalence and impact of early childhood trauma in Chronic Fatigue Syndrome.
Kempke S, Luyten P, Claes S, Van Wambeke P, Bekaert P, Goossens L, Van Houdenhove B.
Department of Psychology, University of Leuven, Leuven, Belgium.
Abstract
BACKGROUND
Although some studies have found high rates of early childhood trauma in Chronic Fatigue Syndrome (CFS), the role of early trauma in this condition remains controversial.
METHODS
This study examined the prevalence of early childhood trauma and its impact on daily fatigue and pain levels over a 14-day period in a sample of 90 carefully screened CFS patients using a diary method approach. Data were analyzed using multilevel analysis.
RESULTS
More than half of the patients (54.4%) had experienced at least one type of early trauma, with the majority of these patients reporting multiple traumas. Prevalence rates were particularly high for emotional trauma (i.e., emotional abuse and/or emotional neglect) (46.7%). Moreover, total trauma scores and emotional abuse significantly predicted higher levels of daily fatigue and pain over the 14-day period, even when controlling for demographic features and depressed mood.
CONCLUSIONS
This is the first study to demonstrate that early childhood trauma predicts increasing levels of core symptoms of CFS in the daily flow of life. Moreover, findings of this study suggest that emotional trauma may be particularly important in CFS.
Finally scientists have spoken out and said that no criteria in use is validated and that CFS, CF and ME are not the same and should be separated. So CF and CFS involved inflammation, but ME is far more then this.
“Thus, ongoing arguments about which definition to use or which illness CFS or ME is the real illness miss the point that none of the definitions meet empirically based criteria for validation.”
“none of these case definitions (CDC or ICC) has passed robust external validation, a serious limitation that hinders advances in classification and the pursuit of biomarkers.”
“Future research should further refine the diagnostic criteria and discriminatory symptoms and biomarkers to delineate ME, CFS, and CF,”
Agree JoT. And at least half of the scientists in the study you mention above appear to have psychiatric or mental health qualifications or work/research in those environments.
Any effective ‘future research’ would include biomedical investigations into a variety of body mechanisms, not just mental function/sleep disorders etc – as important as those are, as long as they are but a part of the wider picture.
Michael Maes has a Phd in neuroimmunology, Gerywn Morris is a clinical chemist. The paper is nothing to do with psychiatry. It is a biological mechanistic review of the scientific evidence. The paper states that those from the Wessely school who have suggested ME is sickness behaviour, the bodies beneficial response to an infection, are incorrect. It isn’t. It is far more then just a response to an initial infection as it is self-perpetuating biological cascade.
Biomedical encompasses psychosocial research. I think you mean biological scientific research.
The last paper would make slightly more sense if the statistics for traumatised children who do *not* have CFS/ME were included.
I would agree that childhood trauma will affect a person throughout their life – because it causes developmental brain damage;
I would agree that it would make having CFS/ME worse – because of the “normal” high levels of stress experienced.
But there is absolutely no evidence to show that childhood trauma CAUSES this vile disease – and I’m utterly sick of this being implied.
It’s simply another case of blame the victim.
They haven’t objectively defined who they were studying under the CFS label. There can’t be a scientific link to childhood trauma.
How interesting to see that in our ailing economy GET isn’t that cost-effective. My own experience is that after a year of ME, I was hoping to return to work part-time (very cost-effective) only to follow a GET programme and relapse so badly I was put in a wheelchair and have never recovered. Not exactly ‘value for money’.