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Treating chronic fatigue syndrome

Chronic fatigue syndrome (CFS) also sometime referred to as myalgic encephalomyelitis (ME) is a relatively common illness affecting around 2% of the population. It can be extremely disabling and places a substantial burden on people, their families and carers, and hence on society. For many years the illness and its treatment was shrouded in uncertainty.

The 'Oxford definition'

Research by Professor Michael Sharpe and his team from the Department of Psychiatry has revolutionised our understanding of the illness. As recently as the 1980s, the illness lacked an agreed clinical definition and was widely regarded as untreatable; patients were simply advised to rest.

In order to meet the challenge of improving the outcome for patients the team first led a national initiative to establish clear diagnostic criteria for the disorder. Published in 1991 and known as the ‘Oxford definition’ these UK criteria have been influential in getting replicable research off the ground and have formed the basis for subsequent international case definitions.

The effectiveness of cognitive behavioural therapy

Once diagnostic criteria were available, Michael’s team conducted careful clinical studies to help them to understand the illness better from the patients’ perspective. Drawing on these studies he devised a treatment based on cognitive behavioural therapy (CBT), which helps patients alter the way they think about and cope with their symptoms.

In a ground-breaking study, published in 1996, the team reported the first ever randomised clinical trial to identify an effective treatment for chronic fatigue syndrome. After one year, 73% of patients who received the CBT reported a significant reduction in their disability compared to only 23% of patients who received medical care alone. This trial disproved the theory that CFS was untreatable and offered patients a therapy based on scientific evidence. The effectiveness of CBT was confirmed in a trial published by a team from Kings College in London and subsequently by numerous independent studies to this day.

CBT is now acknowledged as a cost-effective treatment for chronic fatigue syndrome, benefiting not only the patient but also reducing the burden of care on family members. In England alone, there are now 49 NHS specialist treatment centres for chronic fatigue syndrome treating over 7000 patients a year. CBT is provided at 46 of these centres. 

This pioneering work has had global impact and CBT is now recommended by the Centres for Disease Control in the USA. It has also led to a revaluation of how fatigue should be treated in other conditions such as multiple sclerosis.