Treating Chronic Fatigue Syndrome With Cognitive Behavioral Therapy And Graded Exercise Therapy: How The PACE Trial Got It Wrong



By Harriet Hall in Science Based Medicine.


Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), and the recently-suggested IOM term systemic exertion intolerance disease (SEID), is characterized by long-term fatigue and a host of other symptoms that impair the patient’s ability to function. It sometimes develops after a flu-like illness, but can also come on gradually with no apparent antecedent. The cause is unknown. There is controversy about the diagnostic criteria, and treatment has not been very successful. Between 8-63% of patients improve during follow-up, but fewer than 10% of adult patients return to pre-illness levels of functioning.

A 2001 review in the Journal of the American Medical Association (JAMA) found that cognitive behavioral therapy (CBT) and graded exercise therapy (GET) were the most promising treatments, but the evidence was mixed and the supporting studies had methodological inadequacies. They warned that positive results on subjective measures in these studies did not mean the participants had actually improved their physical capacities. The PACE trial was designed to look for better evidence.


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Link to PACE article

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