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Mind-body: Inside chronic fatigue
February 23rd, 2011
01:54 PM ET

Mind-body: Inside chronic fatigue

Dr. Charles Raison, CNNHealth's Mental Health expert and an associate professor of psychiatry and behavioral sciences at Emory University, writes regularly on the mind-body connection for better health.

Every Wednesday afternoon for the last 10 years I’ve slung a government ID badge around my neck and walked up to the Centers for Disease Control and Prevention, where I set aside my identity as a psychiatrist who studies meditation and take on the role of guest researcher in a group of scientists charged by Congress with studying chronic fatigue syndrome, or CFS.

If ever there was a condition in which the mind and body give rise to disease and acrimony it is CFS. Everyone involved in the disorder is angry. Patients are mad because they are catastrophically disabled by a condition for which no one can find a convincing cause. Researchers are mad because when their findings suggest that CFS has a strong emotional/mental component, patients and their advocacy groups get even madder, reading in these findings everything from government conspiracy to the simple insult that their illness is “all in their head.”

Into this fray comes the largest and most definitive study of how to treat CFS ever done, published last week in the journal Lancet. As one who works in the field I find its results important, hopeful and disappointing. Still, for anyone who struggles with chronic exhaustion, pain or other physical symptoms for which doctors can’t find a cause, the study provides clear guidance about how to best proceed in dealing with your symptoms.

The study randomly assigned 641 people with CFS to receive cognitive behavioral therapy, also known as CBT, in which subjects were guided in thought processes and behaviors including fear of symptoms and helped to succeed in activities;   graded exercise training, in which the participants gradually increased their activity levels to achieve specific goals; adaptive pacing therapy,  in which activity is paced specifically to reduce fatigue, achieve specific goals and provide the best environment for natural recovery; or medical care by a specialist in chronic fatigue syndrome.

A year later all the subjects were evaluated to see which of these treatments had the best long-term effect. More important than the details of the treatments is the fact that the graded exercise training and CBT gently pushed patients to increase their levels of activity and functioning, whereas the adaptive pacing therapy focused on helping the CFS patients live better within the limits of their illness by restricting their activities so as not to become overly exhausted.

The findings were clear. The patients who challenged themselves to improve their condition within the context of CBT or graded exercise got much better on the whole than did those who accepted their disabled fate and tried to live with it within the guidelines of the adaptive pacing therapy. If you’ve got CFS you’ve got to fight for your health by pushing against your pain and exhaustion to get in better mental and physical shape.

But before proceeding, an important caveat. This does not mean that if you have CFS, fibromyalgia or a related condition you should hop up and train for a marathon. A hallmark of both CBT and graded exercise is that they increase activity gradually and require close monitoring to ensure success. These interventions require time and patience and can be completely destroyed by the types of over-eagerness that lead to disease relapse.

So the good news is that even though we don’t understand what causes CFS, it can be treated with behavioral interventions that anyone with the illness can, at least in theory, avail themselves of. This is a cause for some hope.

But there is bad news on at least two fronts. First, despite all the hoopla this study has gotten in the press recently, none of the treatments worked very well. In fact, only one out of three patients improved with either CBT or graded exercise. This means that the majority of people did not improve, despite all their time and effort.
The second piece of bad news derives directly from the first, and that is the fact that the best treatments we have for CFS and related conditions are completely non-specific, which is probably we they don’t work so well. After all, increasing our sense of mental control through CBT and our physical fitness through graded exercise would probably help most of us. Compare this to an antibiotic. If you are well an antibiotic does nothing. If you are in mortal agony from a bacterial infection it saves your life.

What’s the difference between an antibiotic and the treatments studied for CFS? Antibiotics strike directly at the cause of the disease in question. That is why they are so specific and so powerful.

Reading the study I was, in the end, left with a sense of solidarity with patients suffering with CFS and other devastating conditions without a known cause. When you’re sick you’ll take an aspirin if that’s all you’ve got, but you long nonetheless for a treatment that cures the problem. The search for such cures is one of the great challenges facing mind-body medicine in the 21st century.


soundoff (247 Responses)
  1. Informed and healthy

    My experience has shown me that my friends with chronic fatigue got it from chronic exersion and/or stress. Sometimes this
    is from just trying to earn enough of a living in these times, sometimes from being a type A. Either way, common sense may dictate the antidote is chronic rest.

    February 24, 2011 at 14:26 | Report abuse | Reply
  2. John B

    I've been struggling with this disease since 1985 and I try to follow everything in the news regarding it.
    This study is pure crap. It was done on people that suffered from mental illnesses that caused them to be fatigued. It was NOT done on people with Chronic Fatigue Syndrome (CFS). This is proven by the fact that they used the Oxford criteria in selecting study participants.

    The Oxford criteria were published in 1991 and require that the presence of mental fatigue is necessary to fulfill the criteria and symptoms that suggest a psychiatric disorder are accepted.

    The people in this study may have had "chronic fatigue", but I doubt many had "Chronic Fatigue Syndrome".

    It's my belief that the outcome of this "study" was pre-planned to come to present a trumped up conclusion to support incorrect assertions that Chronic Fatigue Syndrome is a psychiatric illness!

    You can read more the details of this study here:
    http://www.medscape.com/viewarticle/737668
    Username: DontBotherMe
    Password: bugmenot

    From the above link:
    "The PACE trial randomized 641 chronic fatigue patients.

    All patients met the Oxford criteria for chronic fatigue syndrome, with some also meeting international criteria for the disorder or London criteria for myalgic encephalomyelitis."

    February 24, 2011 at 14:54 | Report abuse | Reply
  3. KFF

    Dr. John Aucott of Baltimore is actively researching how to better diagnose and treat Lyme Disease. For more information on how to contribute funding to his research please visit http://www.springforlyme.org

    February 24, 2011 at 15:02 | Report abuse | Reply
  4. CalgarySandy

    One in 5 people are mentally ill. The situation with fixing it is pretty much the same. Depression causes pretty awful fatigue in most people. There is idiopathic pain. Cognitive behavior therapy and drugs drugs are most often used together. The problem is that few doctor's actually know how to do CBT and get frustrated and even angry if you do not get cured by their words of wisdom. You are considered "treatment resistant". I.e. it is your fault that the therapy is not working. I suspect that this is the case with Chronic Fatigue. They tell you what to do and send you on your way. My last psychiatrist told me she should would not hold my hand to help me develop healthy habits although she said in our first session that she would.

    After over 20 years looking for help; having given up on the whole search in my early 20's, I am very little improved and that is from a very old medication added to the mix I am already on. The side effects are brutal and I may not be able to continue. Many antidepressants suck the energy right out of you and do nothing to help you get out and go for a walk. One psychiatrist told me I had to chose between anxiety and depression as you can have an upper or a downer but not both. Cymbalta, for instance, turned me into a sloth who could not stand the taste of most food. Of course, it also packed on the pounds making me even more depressed and wondering where the weight was coming from as I wasn't eating. It is likely that it will take a lot of work to find the right combination for people with CFS as it does for other neurological disorders.

    My experience as well as the experience of someone I know with Chronic Fatigue is that doctors do not like people who do not get better. I have heard people accuse both the mentally ill and those with CFS as malingerers. This does not help and causes additional stress to people who already have more than they can handle alone.

    February 24, 2011 at 15:05 | Report abuse | Reply
  5. John B

    If you are interested in REAL news regarding this horrible disease, you should read this story: http://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2011/02/24/spinal-fluid-may-hold-clues-to-lyme-disease-chronic-fatigue-syndrome

    This unbiased study PROVES that ME/CFS is NOT a psychological manifestation, but that there is central nervous system involvement.

    February 24, 2011 at 15:06 | Report abuse | Reply
  6. LauraS

    Of the three people I knew with this all ended up with celiac disease. It takes months to feel better, because the villi have to grown back, but every single one ended up having it.

    February 24, 2011 at 15:36 | Report abuse | Reply
  7. Denise S

    Years ago (30 or so) EBV was thought to trigger celiac disease. Exhausted immune response switches to autoimmune response. Makes sense to me. Kind of like how constant fatigue breeds extreme frustration and stress. Exercise may indeed help, but accepting the viral invasion is the most helpful. Fighting it simply depletes all of the fight or flight hormones and subsequently causes anxiety, depression, etc. Acceptance is, however, easier said than done.

    February 24, 2011 at 15:48 | Report abuse | Reply
  8. DavidB

    Referring to what Paul (near the top) said about having an odd feeling while on the plane then it hit him after that –
    I had a similar experience. One evening I got really dizzy and slightly nauseaus for no apparent reason. I ate and the nausea went away, but not the dizziness. The Dizziness went away over several days. After that, it was like someone had flipped a switch and I was fatigued beyond any experience I'd ever had. It is still with me a year later. I don't have pain, but have suffered cognitively terribly, causing me not to be able to work.
    A "Doctor Consultant" reviewed my disability claim and decided that I have no case – read that as, "he's faking it."

    February 24, 2011 at 16:08 | Report abuse | Reply
  9. Rebecca

    Mr. Raison, I am not understanding something about your that I hope you can explain. First, you write the following: Into this fray comes the largest and most definitive study of how to treat CFS ever done, published last week in the journal Lancet.

    -AND-

    The findings were clear. The patients who challenged themselves to improve their condition within the context of CBT or graded exercise got much better on the whole than did those who accepted their disabled fate and tried to live with it within the guidelines of the adaptive pacing therapy.

    BUT AT THE END OF THE ARTICLE YOU WRITE THIS:
    But there is bad news on at least two fronts. First, despite all the hoopla this study has gotten in the press recently, none of the treatments worked very well. In fact, only one out of three patients improved with either CBT or graded exercise. This means that the majority of people did not improve, despite all their time and effort.
    The second piece of bad news derives directly from the first, and that is the fact that the best treatments we have for CFS and related conditions are completely non-specific, which is probably we they don’t work so well.

    IT SEEMS AS IF YOUR CONTRADICTING YOURSELF. HOW CAN this study be "the largest and most definitive study of how to treat CFS" when you yourself admit GET and CBT do not work on most people with CFS in the study. Further, how can you say that GET works better than PACE, when for most of the persons with CFS in this study, you yourself say, it did not work at all. PLEASE CAN YOU EXPLAIN FURTHER–Why are these contradictions in your article? Why do you claim this is the most definitieve study on CFS and "the findings are clear" when in fact, it "only 1 out of 3 patients improved using CBT or GET. Can you please explain the contradiction?

    February 24, 2011 at 17:33 | Report abuse | Reply
    • Jo

      I agree with Rebecca. This article was full of contradictions. I can't believe they got away with them.
      Anyone who truly knows anything about these illnesses, knows that those things don't work anyway.

      Some of the keys to helping people with long term CFIDS involve correcting methylation pathways. That's a BIG one.
      Also- treating mold related illness, detoxing heavy metals, treating lyme in some cases, and using herbs to treat various viruses and bacterial infections.

      Western medicine has nothing decent to offer that I have found. But saliva testing with proper supplements offers hope.
      I never expect to find cutting edge health info on mainstream sites. That's not where it's at in my experience.

      March 15, 2011 at 01:18 | Report abuse |
  10. Lu

    One out of three – it's exactly the values for placebo effect.
    Bottom line: workout does nothing to help.

    February 24, 2011 at 17:36 | Report abuse | Reply
  11. Chris

    I feel for every person who who has responded to this article. I am wondering if anyone has tried reducing their exposure to EMF (and dirty electricity) to see if there is at least an improvement with some of the worst symptoms. Cell towers, dect phones, cell phones, wifi, 'low energy' light bulbs and poor wiring can have a devastating effect on those who are the most sensitive to this type of radiation. Just something to consider that may help a few.

    February 24, 2011 at 17:43 | Report abuse | Reply
  12. Breezy

    I wonder how many people with CFS will someday end up showing symptoms of an autoimmune disease in the future. Lupus, and connective tissue diseases can start out this way. Reactive arthritis can be brought on by many bacterial illnesses. I am lucky that my disease is one that is now, recognised, but was poo-pooed just like CFS for many decades.

    It is so great that some can get improvements from dietary changes. Celiac sprue is a major problem which needs to be taken very seriously. Unfortunately, there are many other dietary problems to take in to account, that are frequently ignored. In my case, my allergy is to oat avenin, not wheat glutens. So many docs wanted me on a gluten free diet, but it was amazing to see the change when I eliminated oats. I read every single label in the miniscule amount of processed food I eat for any oat products. It even causes my skin to split if it is in lotions. Wheat is no problem. This just goes to show that we all react differently, and our diseases are different. It sure makes sense to try everything -food diaries, exclusion diets, tests for EBV, and Lyme, Magnesium (works great), other mineral defiencies, thyroid trouble, and autoimmune diseases

    February 24, 2011 at 18:32 | Report abuse | Reply
  13. Diane S.

    CNN: Your headline writer is ignorant. "Chronic Fatigue" and "Chronic Fatigue Syndrome" are NOT the same thing. One means that you're tired. The other means that you have a crippling myriad of symptoms (including chronic fatigue) which basically blow your life all to hell.

    February 24, 2011 at 19:21 | Report abuse | Reply
  14. Joyce Farrell

    My high fever in 1986 & inability to work for some time was diagnosed as CFS, however my working part-time for 6 months was the saving grace which brought me back to my wonderful work which I wasn't prepared to give up at any cost, mind-over-matter, saw me working full=time again after 1 year. Joining a support group gave me some insight into what I did not wish to become, namely, a bed-ridden, whining, drain on society, as such I just got on with it all which wasn't easy but necessary. Giving up my boyfriend who wasn't understanding was a simple decision c/w a sugar-free diet & salt added to my diet since most CFS patients are non-salt users, a slower pace, taking time to smell the roses, dropping the A-type personality became the order of the day for this, 25+ year survivor, however, CFS comes knocking at my door every so often & I open up to it since I know when I have gone back to my old Type-A personality & it is time-out again; as my Dr. advises me, some people get CFS, others fatal heart attacks since death is nature's way of telling a person to slow down!

    February 24, 2011 at 19:50 | Report abuse | Reply
  15. sharon stapleton

    Mind-Body is the biggest load of dangerous garbage there is. This Lancet "study" was not a true study, it was ginned up rubbish by Simon Wessely, his wife Trudie and the rest of the UK psychobabble sociopaths. We are physcially sick and all the GET and CBT is NOT going to cure the real damage to our bodies. Get real please. The game is almost over and the shrinks will be out of a job. The CDC in the US and the Wessely group in the UK will be investigated, prosecuted and placed in prison. And millions and milllions of ME/CFS sick may finally get what they have deserved for 30 plus years.
    No more stories on the BS mind-body connection when dealing with a very real and very deadly disease. Next time do some real research on the deadly third human Retrovirus. See http://www.mcwpa.org for starters on that deadly human retrovirus that the US CDC and the UK Wessely Mind-Body people are trying to keep covered from the public.
    ====================================================

    Spinal fluid proteins distinguish lyme disease from chronic fatigue syndrome
    Posted On: February 23, 2011 – 10:30pm
    http://www.sciencecodex.com/spinal_fluid_proteins_distinguish_lyme_disease_from_chronic_fatigue_syndrome
    Patients who suffer from Neurologic Post Treatment Lyme disease (nPTLS) and those with the Chronic Fatigue Syndrome report similar symptoms. However unique proteins discovered in spinal fluid can distinguish those two groups from one another and also from people in normal health, according to new research conducted by a team led by Steven E. Schutzer, MD, of the University of Medicine and Dentistry of New Jersey – New Jersey Medical School, and Richard D. Smith, Ph.D., of Pacific Northwest National Laboratory. This finding, published in the journal PLoS ONE (February 23, 2011), also suggests that both conditions involve the central nervous system and that protein abnormalities in the central nervous system are causes and/or effects of both conditions.
    The investigators analyzed spinal fluid from three groups of people. One group consisted of 43 patients who fulfilled the clinical criteria for Chronic Fatigue Syndrome (CFS). The second group consisted of 25 patients who had been diagnosed with, and treated for, Lyme disease but did not completely recover. The third group consisted of 11 healthy control subjects. "Spinal fluid is like a liquid window to the brain," says Dr. Schutzer. By studying the spinal fluid, the research team hoped to find abnormalities that could be used as markers of each condition and could lead to improvements in diagnosis and treatment.
    Taking advantage of previously unavailable methods for detailed analysis of spinal fluid, the investigators analyzed the fluid by means of high powered mass spectrometry and special protein separation techniques. They found that each group had more than 2,500 detectable proteins. The research team discovered that there were 738 proteins that were identified only in CFS but not in either healthy normal controls or patients with nPTLS and 692 proteins found only in the nPTLS patients. Previously there had been no available candidate biomarkers to distinguish between the two syndromes, nor even strong evidence that the central nervous system is involved in those conditions.
    This research represents the most comprehensive analysis of the complete CSF proteome (collection of proteins) to date for both Chronic Fatigue Syndrome and Neurologic Post Treatment Lyme disease (nPTLS). Prior to this study, many scientists believed that CFS was an umbrella category that included nPTLS. However these results call those previous suppositions into question.
    According to Dr. Schutzer, spinal fluid proteins can likely be used as a marker of disease, and this study provides a starting point for research in that area. "One next step will be to find the best biomarkers that will give conclusive diagnostic results," he says. "In addition, if a protein pathway is found to influence either disease, scientists could then develop treatments to target that particular pathway."
    "Newer techniques that are being developed by the team will allow researchers to dig even deeper and get more information for these and other neurologic diseases," says Dr. Smith. "These exciting findings are the tip of our research iceberg"

    February 24, 2011 at 22:04 | Report abuse | Reply
  16. Pamela Arrington

    I have had Fibro and CFS for four years. I finally found a doctor who did some Herpes class viruses serology. I was positive for several of them . I have been on Acyclovir for 3 months and have energy again. Here's Dr. Dantini's wesite. It's worth a check. It helped me trememdously. Namaste. http://www.4fibromyalgia.com

    February 25, 2011 at 00:55 | Report abuse | Reply
  17. Maybejustsaying

    I'm confussed I thought this was already figured out. CFS is brought on by a virus, HHV6. This virus is passed down through DNA. We all,100% have this virus, it's just active in a few.

    February 25, 2011 at 08:42 | Report abuse | Reply
    • mark

      Wow I didn't know that.

      February 26, 2011 at 19:59 | Report abuse |
  18. ccm

    I can't understand why this article has ignored the XMRV research. The CDC is so concerned this is a virus that they have recommended CFS patients not give blood. I have no doubts in my mind that CFS is viral. I've been very active my whole life. I've been a psychotherapist for over 20 years. Nov. of 2009 I planned my 40th wedding anniversary. I did everything for it–planned it, decorated, catered it etc. It was very time consuming and took a lot of energy to pull it off and then have a blast with our 60 plus family and friends. Two months later I started training with the goal of running a 10k by the end of the year. I ran my first 5k in April. I felt fine afterward and was very excited that I was moving toward my goal and began to think I might be able to run the 10k sooner than the end of year. In May I ran my second 5k. I felt good running, wasn't all that tired that day and then it hit me like a ton of bricks. It took me a week to recover. My practice runs on the treadmill at the gym got harder and harder and about 12 hours after those runs I was completely exhausted. I started wondering how in the heck I was able to pull off the Anniversary party. Just thinking about all I did for it made me exhausted. I started having strange symptoms like losing my hair, brain fog, and uncontrolled sleepiness. When I fell asleep in two different therapy sessions with clients, I knew something was drastically wrong. My doctor recommended many things and then finally tested me for EBV. My test showed that I had a history of having had EBV, which I already knew, that I didn't have an active case of it, but that I was presently building antibodies for EBV. Last Oct. I was finally diagnosed with CFS. I quit running after reading that aerobic activities make CFS paitients worse. I've had no depression with this disorder. However, I am definitely grieving having to stop running. I am having fears about what all this means for my future and am frustrated with the lack of clear, reliable info on how to feel my best. In the last 5 months I have felt somewhat better. Not running or aerobically excising, taking meds to help me get more restorative sleep, taking a thyroid medication, and taking several recommended supplements seems to be addressing some of my symptoms (I've only listed a few out of about 15 that I have). I've decided that it's worth trying to experiment with the aerobic exercise and have been doing run/walk intervals. As before I feel great while I'm exercising. So far, the exercising has been OK. I'm not the least bit confident that I can reach the level of exercise I desire without severe consequences. The research and the anecdotal stories I have read don't make me hopeful, but I'm going to experiment in an effort to see what works for me. With the many symptoms I have had it is very obvious this is a virus and that like all viruses it has an effect on every bodily system. Over the years I have had a few clients with diagnosed CFS and clients who I suspect might have had CFS but were diagnosed by their psychiatrist with depression. I also have a friend who has it. I sadly leaned toward CFS being more emotional/mental than physiological Wow, do I know now how wrong that was.

    February 25, 2011 at 13:27 | Report abuse | Reply
    • mark

      Hey bro you are lucky you can run, I find I can only do 6 minutes walking every second day but if I do a gentle 20 minute walk I end up in bed for 1 week and it takes 4 weeks to recover. You are so lucky you can do more than me far out.

      February 26, 2011 at 19:44 | Report abuse |
  19. marehorse

    What about treatment with IGg infusions?? Expensive, but I'll fight my insurance co. if not approved ! Dr. doesn't know for sure if this will help, but I'll try anything~anyone done infusions for CFS?

    February 25, 2011 at 13:31 | Report abuse | Reply
  20. marehorse

    Infuions might work. Anyone had them ?? I'll try anything, and that's next on my list !

    February 25, 2011 at 13:33 | Report abuse | Reply
  21. ccm

    The XMRV virus is no ordinary virus. It's a retrovirus. Retroviruses can't be cured because they mutate too quickly. However, recently "the Berlin Patient" was cured of AIDS, another retrovirus, with stem cell treatments.

    February 25, 2011 at 13:46 | Report abuse | Reply
    • mark

      Wow I hope I can get stem cell treatment to fix me I am 22 have CFS and don't want to have it for the rest of my life, I want to get a job I want to travel the world I want to be successful I am so ambitious at my age.

      February 26, 2011 at 19:41 | Report abuse |
  22. mark

    I am 22 years old. I used to cycle from the ages of 12-16, 25 miles everyday and from the ages of 16-20 I was cycling 50 miles everyday then I got sick never fully recovered and have M.E/CFS. I came down with CFS when I was 21 and a half years old, so I have had it for 1 year 3 months now as I am turning 23 in a couple of months. I find going for a 6 minute walk in the forest next to my house every 2 days helps my fatigue, but if I do a 20 minute walk I end up in bed for a whole week and it takes 4 weeks to recover.

    February 26, 2011 at 19:39 | Report abuse | Reply
    • Roberto Valderde

      This kind of trouble has total solution in Guadalajara, Mexico. I have found the answer during the last 10 years. It's a system using magnetos.
      Treatment can be send to everywhere.
      Roberto Valderde

      May 27, 2011 at 13:26 | Report abuse |
  23. Susan

    I've suffered from CFS since 1991, and was diagnosed with fibromyalgia a few years later. In the beginning it was very rough. I couldn't get out of bed and had to move home for awhile to be taken care of by my parents. I fought the disease and went back to work, only to keep relapsing on and off for almost 10 years. I had all of the side effects including fainting spells, so I became hesitant to go out or make plans with friends. I also tried every kind of therapy known to man. Certain ones helped for awhile and then stopped, so I would try others.

    What finally helped me were two things. One, medication that helped me sleep through the night. I hadn't had a good night's sleep in years, and my body did not the means to repair and recharge. The second thing was that I decided I was not going to identified solely by my disease. I was much more than that, just like anyone else living with a serious condition.

    I picked up and moved from NYC to CA where I started to live again. I still take a lot of medicine (mostly for migraines and nerve pain), and have weekly ups and downs, but I've learned to listen to my body. I walk a lot which has helped my both mentally and physically and makes me appreciate just how lucky I am.

    February 27, 2011 at 00:55 | Report abuse | Reply
  24. Kelly Latta

    I'm sure Dr. Raison did not mean to forget about the extramural biomedical researchers whose work has been largely ignored or buried under the misapprehension that like ACT UP before them it is patients vs psychiatrists.

    And because he was writing for a lay audience he may have felt it wasn't pertinent to mention that the PACE trial used a rarely used definition to define their cohort – and not one researchers who have found positive results for pacing use or researchers who study exercise induced abnormalities. It is scientifically shaky to extrapolate results from one subgroup to a completely different subgroup. Apples and oranges may both be round fruit, but are very different. This is where the use of biomarkers such as researchers report finding that differentiates CFS patients is very important. Biomarkers allow researchers to be sure they are studying the same disease.

    And as noted by Dr. Raison, these results were not as significant as they first appeared. an examination of the endpoints between the protocol originally registered showed that ‘recovery,’ as defined originally , required an SF-36 PF score of 85 or over, however the final endpoints published were measured as: ‘back to normal’ – which only needed a SF-36 PF score of 60. Inclusion criteria for the trial required that patients have “severe and disabling fatigue” – this included SF-36 PF scores of up to 65. But, it did not require post exertional malaises lasting more than 24-hours unrelieved by rest. Staying within the energy envelope is very important for patients with post exertional malaise.

    In other words, they changed their endpoints to make their results look more significant than they really were. CBT can be an effective coping tool, but there is no scientific evidence that it "cures" or "reverses" any disease.

    March 3, 2011 at 12:56 | Report abuse | Reply
  25. Damien Woody

    It is growing in the United States the participation of people suffering from this syndrome. Findrxonline mentions that in recent months five out of ten people suffer from some symptom of this disease and therefore have to resort to medications including vicodin or hydrocodone to control pain that produces them chronic fatigue syndrome.

    March 4, 2011 at 14:14 | Report abuse | Reply
  26. dr jmichel

    this is a bad misrepresentation of a study. If Dr. Raison cant do a better job that this, he isnt fit to comment health matters at all. The PACE study is do riddled with confounds it is astounding that Lancet published it in the first place.

    Dr. JMMP

    March 13, 2011 at 20:42 | Report abuse | Reply
  27. Roberto Valderde

    Roberto Valverde's phone in Guadalajara, Mexico is 56 33 36424834.
    We invite you to see the movie: MEDICINES KILL, MAGNETS CURE.

    May 27, 2011 at 13:32 | Report abuse | Reply
    • Roberto Valderde

      This movie can be seen in youtube.com

      May 27, 2011 at 13:33 | Report abuse |
  28. fatiguesyndrome

    The study seems to have aimed slightly off the mark, and it was also admitted at the end – the treatments were too nonspecific. It is absolutely necessary to explore the reasons and mechanisms behind this condition in order for it to be cured. Otherwise you can try a thousand methods over decades and still not find a solution. The real cause of chronic fatigue syndrome, according to my experience, is emotional overload – an unresolved burden of traumas, stress, worry, anxiety, and fear. That's what needs to be addressed.

    November 25, 2011 at 09:14 | Report abuse | Reply
  29. Simon Wilby smartpower

    Smart mouth mobile has yet to let me down. I have not experienced any dropped calls. Thank goodness for the unlimited texting feature, between me and my kids my texting is endless. The apps are simple and easy to download. I am satisfied with my service, there were no hidden fees or surprises when I got bill. You get exactly what you pay for good service!!!

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