Early intervention for CFS in primary care

Early intervention approaches aim to prevent chronic fatigue syndrome by addressing symptoms at an early stage in people who are identified as at risk of developing CFS, for example people with fatigue lasting between one and three months with no known cause. However, the exact mechanism that triggers people to develop CFS is largely unknown which may affect early intervention studies.

"Early intervention" does not imply that any particular treatment is being used, but has been used for trials involving biopsychosocial rather than biomedical treatments. O'Dowd et al (2020) recently published a clinical trial involving the use of psycho-education and cognitive behavioral therapy.

Theory: Biopsychosocial hypothesis
Early intervention studies generally follow the biopsychosocial model of ME/CFS which is based on theory that symptoms are caused by the physical effects caused by a mixture of behavioral and thinking habits, known as illness beliefs.. For example, a person who is ill reduces their activity, and this causes deconditioning, which the theory claims causes symptoms such as muscle pain or sleep dysfunction.

However the biopsychosocial hypothesis has become extremely controversial, particularly since the re-analysis of the PACE trial data, and there are increasing findings of physical abnormalities, most of which cannot be explained by deconditioning or cognitive and behavioral responses to illness, for example immune system markers, and abnormal responses to exercise.

Evidence
A feasibility study did not find evidence for the efficacy of such an intervention. This trial attempted to address fatigue as the main symptom of CFS, rather than post-exertional malaise. It did not find that a randomized controlled trial to test the intervention was feasible, and reasons for this included:
 * GPs not being able to identify enough patients meeting the researcher's criteria, so recruitment was less then half of the 100 patients expected
 * GP reluctance to carry out screening tests at such as an early stage
 * GPs referring patients for fatigue who were unlikely to develop CFS
 * Some patients who dropped out stating that they did not accept the theory behind the trial or treatment

Costs and availability
Generally not available.

Criticism
Action for ME were referred to in the 2020 report as providing "advice and support" during the study. Sonya Chowdhury, chief executive of Action for ME, responded by stating that this was before her time at Action for ME and her role as CEO, that the charity would not support this type of study in the present, and describing the current research strategy.

Action for M.E.’s Chief Executive at the time provided a letter of support to the project on 11 January 2011 and commented on the ‘Research for Public Benefit’ form submitted as part of the application. A member of staff attended a small number of research team meetings to offer support. The study did not succeed and would not be the type of study that Action for M.E. would support now."

Notable studies

 * 2020, The feasibility and acceptability of an early intervention in primary care to prevent chronic fatigue syndrome (CFS) in adults: randomised controlled trial (Full text)