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.
[edit | edit source]
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[edit | edit source]
A feasibility study proved evidence that such early intervention was unsuccessful. This trial attempted to address fatigue as the main symptom of CFS, rather than post-exertional malaise. 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
Risks and safety[edit | edit source]
Costs and availability[edit | edit source]
Generally not available.
Criticism[edit | edit source]
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."||”|
—Sonya Chowdhury, Chief executive of Action for ME
Notable studies[edit | edit source]
- 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)
See also[edit | edit source]
References[edit | edit source]
- O’Dowd, Hazel; Beasant, Lucy; Ingram, Jenny; Montgomery, Alan; Hollingworth, Will; Gaunt, Daisy; Collin, Simon M.; Horne, Sarah; Jones, Beth; Crawley, Esther (May 12, 2020). "The feasibility and acceptability of an early intervention in primary care to prevent chronic fatigue syndrome (CFS) in adults: randomised controlled trial". Pilot and Feasibility Studies. 6 (1): 65. doi:10.1186/s40814-020-00595-0. ISSN 2055-5784. PMC 7216523. PMID 32426159.
- "CEO comment on early intervention study for CFS". Action for ME. May 18, 2020.
Action for ME (AfME) - Action for ME is a British non-profit organization that was set up in 1987 as The M.E. Action Campaign. Its founders were Martin Lev, Sue Findlay and Clare Francis. In September 1993 it changed its name and logo to Action for ME and Chronic Fatigue. It then changed its name in 1993 to Action for ME.
myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.
randomized controlled trial (RCT) - A trial in which participants are randomly assigned to two groups, with one group receiving the treatment being studied and a control or comparison group receiving a sham treatment, placebo, or comparison treatment.