Two Treatments for Chronic Fatigue Top the List
Sept. 19, 2001 -- Chronic fatigue is a perplexing medical problem for patients and doctors, and so far, there are no great answers for treating it. But researchers are furiously looking for which treatments seem to lead the pack in helping people with this crippling disease.
Doctors do not know what causes chronic fatigue. Close to a million people in the U.S. are affected by this mysterious ailment with symptoms of fatigue, headaches, muscle pain, and difficulties with sleep and concentration.
British researchers looked at hundreds of studies evaluating treatments for chronic fatigue and narrowed the list to the best 44. After their extensive review, they found that treatments called "cognitive behavioral therapy" and "graded exercise therapy" seemed to offer people with chronic fatigue the most relief, compared to everything else out there.
Yes, cognitive behavioral therapy is a type of psychotherapy, but experts in the field are quick to point out that this does not mean that the illness "is all in the patient's head." They agree that chronic fatigue is a real physical illness and that cognitive behavioral therapy just happens to work quite well.
With cognitive behavioral therapy, patients work with a therapist to learn ways to cope with the illness and to try to put a halt to the symptoms and regain control over life. The therapist takes an active role in helping a patient learn to solve daily problems associated with chronic fatigue.
But with regard to the graded exercise therapy, how does someone with chronic fatigue even start thinking about exercise? This therapy is a specialized approach that has been shown to work particularly well for people with the illness.
With graded exercise, patients start very, very slowly. And very, very slowly means exactly that. It might even mean riding a stationary bike for a couple of minutes or even walking to the end of the driveway and back a couple of times and working up from there. This has been shown to help break people with chronic fatigue out of the vicious cycle of fatigue causing lack of activity and thus more fatigue.
These same researchers also found medications, including the steroid hydrocortisone and antibody or immunoglobulin injections, were largely ineffective in helping people with chronic fatigue. In addition, they were unable to identify any supplements or complementary/alternative treatments that seemed to work.
Although these two treatment approaches -- cognitive behavioral therapy and graded exercise therapy -- are not the final answer for chronic fatigue sufferers, Simon Wessely, MD, says that currently they are the best available treatment options. He is with the department of psychological medicine at Guy's King and St. Thomas School of Medicine in London.
In an editorial accompanying the study, Wessely says that rejecting these treatments because of their perceived association with psychological treatments would be a step backward and would do a great disservice for chronic fatigue sufferers who simply want some help.
From the Sept. 19 issue of TheJournal of the American Medical Association.