CHRONIC FATIGUE SYNDROME

The investigation and management of Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME) in children and adults

Background

The aim of this systematic review was to produce a broad overview of the evidence relating to the diagnosis and treatment of CFS/ME in adults and children. The review was divided into four parts: case definition, diagnosis, treatment/management and information/support needs. The main part of the review involved updating two previously published systematic reviews concerning the treatment/management of CFS/ME, one of which was carried out by CRD in 2002. The review was used to support the development of guidelines by the National Institute for Health and Clinical Excellence (NICE) for the investigation and management of CFS/ME.

Findings

Studies on behavioural, immunological, pharmacological, complementary, nutritional supplements and miscellaneous interventions were identified. Graded exercise therapy and cognitive behaviour therapy appeared to reduce symptoms and improve functioning, based on evidence from randomized controlled trials. For many other interventions, the evidence of the effectiveness was inconclusive, results were in need of replication or the treatment was associated with substantial adverse effects. Very little evidence was found to guide the treatment of children and those severely affected with CFS/ME.

Eighty studies met the inclusion criteria, of which seven were case definitions. The other studies aimed to validate a case definition or to define differences between people with and without CFS/ME. Validation of case definitions remains problematic in the absence of a reliable independent diagnostic test.

Twenty-seven studies met the inclusion criteria. All but six were of a low level of evidence (case-control studies or consensus guidelines). Overall, no definitive diagnostic test has been described for CFS/ME.

Generally, included studies indicated a need for more information and support. Information on treatment and management as well as general information about CFS/ME were most commonly requested. The need for an understanding and supportive attitude was also highlighted in several studies. No studies were found that evaluated the effectiveness of ways of meeting the information and support needs of patients, carers or health professionals.

Conducted by: Duncan Chambers1, Anne-Marie Bagnall2, Susanne Hempel1, Carol Forbes1

1. Centre for Reviews and Dissemination; 2. School of Health and Community Care, Leeds Metropolitan University

Related guidance

Commissioned to inform NICE Clinical Guideline 53 Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management of CFS/ME in adults and children. London: National Institute for Health and Clinical Excellence; 2007

Publications

Centre for Reviews and Dissemination. The treatment and management of chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) in adults and children: update of CRD Report 22. CRD Report 35. York: University of York. 2007

Centre for Reviews and Dissemination. Effective treatments for CFS/ME. CRD Report 35. York: University of York. 2006

Chambers D , Bagnall AM, Hempel S, Forbes C. Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. J R Soc Med. 2006;99:506-20

Hempel S, Chambers D, Bagnall AM, Forbes C. Risk factors for chronic fatigue syndrome/myalgic encephalomyelitis: a systematic scoping review of multiple predictor studies. Psychol Med. 2007;38(7):915-26

Posters

Hempel S, Bagnall AM, Chambers D, Forbes C. Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME): results of a systematic review. British Psychological Society Annual Conference; 2006 March; Cardiff, UK

Presentations

Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME). CFS Network Conference; 2005 October; Leeds, UK

Forbes C. NICE chronic fatigue syndrome-ME guideline: proposed review of the evidence'. NICE Stakeholders Meeting; 2004 November; London, UK

Funding

Commissioned by the National Collaborating Centre for Primary Care