From the ‘Daily Telegraph', Doctor's Diary 9 November 2015 (Words by Dr James Le Fanu).
In medicine, as in life, it is sensible to be cautious about claims that seem too good to be true. Back in 1999, software engineer Ollie Cornes contracted a throat infection that transmuted into a state of “unbelievable exhaustion, with an intense flu-like malaise”, leading to him eventually being diagnosed as having postviral fatigue syndrome.
Since then, the severity of his fatigue has waxed and waned, but is invariably exacerbated by doing more than his usual level of activity allows – leaving him “bedridden for weeks with muscle weakness, dizziness and loss of appetite”. This phenomenon of fatigue following minimal physical or mental exertion is a well recognised feature of many neurological disorders, affecting two thirds of those with multiple sclerosis and being almost universal in the Post Polio Syndrome (PPS) that afflicts the survivors of the polio epidemics of the 40s and 50s. The precise mechanism remains obscure, but is obviously related to disturbed functioning of the relevant parts of the brain.
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By contrast, the mainstream medical explanation for those like Mr Cornes with post-viral fatigue – otherwise known as chronic fatigue syndrome, or, even more commonly, ME (myalgic encephalomyelitis) – is very different, being attributed to the “unhelpful belief they have some persistent medical condition” that is exacerbated on exertion. This results, it is claimed, in a “chronic fatigue state in which symptoms are perpetuated by a cycle of inactivity and deconditioning with further deterioration in exercise tolerance”.
Hence the proposal that breaking this cycle with a combination of cognitive behavioural therapy together with a regime of graded exercise should promote recovery. And, indeed, as reported in this paper last week, researchers at Oxford University who have evaluated this approach found that, two years later, “most” patients had benefitted feeling less tired and being able to complete most tasks more easily”.
The researchers may be persuaded by their optimistic conclusions, but Telegraph readers certainly are not, as is clear from the impressive number (more than 1,200) of highly critical comments posted online, drawing attention to, for example, the remarkable absence of any measurable criteria for assessing what “recovery” entailed. It is far too good to be true to suppose that positive thinking and graded exercise should reverse a debilitating illness that, as with Mr Cornes, can last for decades – and it would be good to think the sheer implausibility of asserting otherwise could be the last hurrah for the psychological explanation for post-viral fatigue.
Earlier this year, the Institute of Medicine in the United States, having reviewed all the medical evidence on chronic fatigue over the past 50 years, advised it be classified as a physical brain disorder, which in view of its “complexity and severity” should be redesignated Systemic Exertion Intolerance Disease, the better to reflect its defining feature: that “physical and cognitive exertion adversely affect these patients in many aspects of their lives”.