Despite previous evidence that both cognitive behavioral therapy (CBT) and graded exercise therapy (GET) can be effective treatments for chronic fatigue syndrome (CFS), some patients’ organizations have reported that these treatments can be harmful and instead prefer pacing and specialist medical care (SMC). The PACE trial, published Online First and in an upcoming Lancet, shows that while CBT and GET have positive effects on CFS when combined with SMC as compared to SMC alone, adaptive pacing therapy (APT) with SMC is no more effective than SMC alone.
In PACE, 640 patients were assigned to one of SMC alone (160 patients), SMC/CBT (161), SMC/GET (160), and SMC/APT (159). After a follow-up of 1 year, mean fatigue and physical function scores had improved more after CBT and GET than after both APT and SMC alone. Serious adverse reactions to treatment were recorded in two APT patients (1%), three CBT patients (2%), two (1%) GET patients, and two (1%) in the SMC-only group.
The authors conclude: "We affirm that cognitive behavior therapy and graded exercise therapy are moderately effective outpatient treatments for chronic fatigue syndrome when added to specialist medical care, as compared with adaptive pacing therapy or specialist medical care alone. Findings from PACE also allow the following interpretations: adaptive pacing therapy added to specialist medical care is no more effective than specialist medical care alone; our findings apply to patients with differently defined chronic fatigue syndrome and myalgic encephalomyelitis (ME) whose main symptom is fatigue; and all four treatments tested are safe."
The group plans to report in the near future on cost-effectiveness of these various treatments, and says that since even CBT and GET offer only a moderate improvement in symptoms, research into new effective treatments must go on.
