In England, the National Institute for Health and Care Excellence (NICE) published a new Clinical Guideline on ME/CFS last year that determined the controversial Lightning Process should not be recommended as a treatment for this medical condition:
1.12.27 Do not offer the Lightning Process, or therapies based on it, to people with ME/CFS.
For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on the Lightning Process.The Full NICE Guideline on ME/CFS (Pages 41 and 83ff)
- See The ME Association position statement on the Lightning Process and a review of the SMILE trial at the bottom of this blog
In New Zealand, Dr Ros Valings has had her own views of the Lightning Process published and endorses The ME Association's and NICE's position:
‘The Lightning Process’ and chronic fatigue syndrome/myalgic encephalomyelitis
As Medical Advisor to the NZ ME Association (ANZMES) and having worked in this area of medicine for 40 years, I am concerned that recent GP educational events have promoted ‘The Lightning Process’,1,2 predominantly used for treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). I do not consider that this is a treatment that GPs should be advocating for use in people with CFS/ME.
The Lightning Process is a treatment offering psychological management and potential ‘cure’ for an illness with disordered immunological and biochemical parameters. There is strong evidence, in particular research by Prof Warren Tate (Otago) and Prof Sonya Marshall Gradisnik (Queensland) confirming immunological changes. The Otago research has shown that a SWATH-MS analysis of ME/CFS peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction.3 This supports a model of deficient ATP production in ME/CFS, compensated for by upregulation of immediate pathways upstream of Complex V that would suggest an elevation of oxidative stress. There were 20–30 times higher unstable genetic codes. A second study has shown evidence of neuroinflammatory changes.4
The Queensland research which looked at transient receptor potential (TRP) pathology found that in ME/CFS patients’ natural killer cells there are fewer functioning TRPM3 receptors and some are defective.5 TRPM3 receptors control movement of calcium in and out of cells. Damaged single-nucleotide polymorphism leads to decrease in the TRPM3 receptors causing changed function leading to decreased intracellular calcium in cells and impaired lysis. These abnormalities affect many systems throughout the body, leading to multiple symptomatology.
While I acknowledge that psychologically-based therapies such as the Lightning Process can have benefit for some patients with any illness, ‘curing’ a serious illness such as ME/CFS is unlikely. The UK ME Association describes the Lightning Process as a commercial treatment programme promoted as a cure for ME and CFS. A combination of neurolinguistic programming and osteopathy, its exponents claim that it can cure the condition in 3 days.
The UK ME Association recommends that the ‘The Lightning Process is not a treatment that we endorse or recommend for people with ME/CFS’ (Dr Charles Shepherd, Medical Adviser). It views this intervention as using an over-simplistic and largely psychological model of ME/CFS causation that is totally out of step with emerging scientific evidence as to its cause. Further, The UK Advertising Standards Authority have upheld complaints relating to therapeutic claims being made for the Lightning Process.
It is also important to note that the recent National Institute for Health and Care Excellence (NICE, UK) updated clinical guidelines for management of ME/CFS recommend that the Lightning Process, or therapies based on it, should not be offered to people with ME/CFS.6 NICE came to this conclusion after a rigorous evaluation of the evidence base.7
I would therefore recommend extreme caution in promoting this expensive treatment modality without careful evaluation of its suitability.
 GoodFellow Symposium. The Lightning Process Training. 26–27 March 2022. Available at https://www.goodfellowunit.org/node/946722
 GP CME Rotorua. The Lightning Process Training – Evidence Based option for Patients who are ‘Stuck’ (WS#166). 11 June 2022. Available at https://www.gpcme.co.nz/speakers.php
 Sweetman E, Kleffmann T, Edgar C, et al. A SWATH-MS analysis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction. J Transl Med 2020; 18 365
| A SWATH-MS analysis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction.Crossref | GoogleScholarGoogle Scholar |
 Tate W, Walker M, Sweetman E, et al. Molecular mechanisms of neuroinflammation in ME/CFS and long COVID to sustain disease and prevent relapse. Front Neurol 2022; 13 877772
| Molecular mechanisms of neuroinflammation in ME/CFS and long COVID to sustain disease and prevent relapse.Crossref | GoogleScholarGoogle Scholar |
 Eaton-Fitch N, Du Preez S, Cabanas H, et al. Impaired TRPM3-dependent calcium influx and restoration using Naltrexone in natural killer cells of myalgic encephalomyelitis/chronic fatigue syndrome patients. J Transl Med 2022; 20 94
| Impaired TRPM3-dependent calcium influx and restoration using Naltrexone in natural killer cells of myalgic encephalomyelitis/chronic fatigue syndrome patients.Crossref | GoogleScholarGoogle Scholar |
 National Institute for Health and Care Excellence (NICE). Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management. NICE guideline [NG206]. 2021. Available at https://www.nice.org.uk/guidance/ng206
 National Institute for Health and Care Excellence (NICE). Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management. Evidence reviews for the nonpharmacological management of ME/CFS. NICE guideline [NG206]. 2021. Available at https://www.nice.org.uk/guidance/ng206/evidence/g-nonpharmacological-management-of-mecfs-pdf-9265183028
- Reply to Ros Valings by Lightning Process proponents Bruce Arroll and Jenny Oliver | 30 September 2022
- ME Association Statement: Lightning Process and SMILE trial in young people with ME/CFS | 19 September 2017
- ME Association Review: The SMILE trial – a lesson in how not to conduct clinical trials in people with ME/CFS | 12 October 2017