The PACE trial in chronic fatigue syndrome

Abstract

A very controversial paper was published on March 5, 2011, about treatments for chronic fatigue syndrome (CFS).1White PD Goldsmith KA Johnson AL on behalf of the PACE trial management groupComparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial.Lancet. 2011; 377: 823-836Summary Full Text Full Text PDF PubMed Scopus (620) Google Scholar I have suffered from this disease for more than 20 years and have been nearly bedridden for the past few years. I hope that the study will be beneficial for patients with CFS. Surprisingly, patients who participated in the study were young, and their symptoms were mild to moderate. Furthermore, their disease duration was short, and they were still in the process of adjusting to the fact that they had an illness whose cause is not known. Probably, the participants learned coping skills through self-help strategies.2Carruthers BM van de Sande MI Myalgic encephalomyelitis/chronic fatigue syndrome: a clinical case definition and guidelines for medical practitioners.http://sacfs.asn.au/download/consensus_overview_me_cfs.pdfGoogle Scholar Cognitive behaviour therapy and graded exercise therapy can be effective for many chronic diseases other than CFS. As this study showed, it is reasonable that cognitive behaviour therapy and graded exercise therapy are effective for CFS. However, whether these treatments will be effective for patients with severe CFS who need medical support remains unknown. I am concerned that this study might lead to further misunderstanding of this disease. In Japan, much research on fatigue in general has been done, but more severely ill patients have been totally overlooked. We need more research where those patients are involved. We are sincerely hoping that the researchers will focus on the biological roots of CFS, so that eventually a cure can be found. I declare that I have no conflicts of interest. Patients' power and PACEOnce every few years, we publish a paper that elicits an outpouring of consternation and condemnation from individuals or groups outside our usual reach. The latest topic to have caused such a reaction is chronic fatigue syndrome (CFS), and—more specifically—Peter White and colleagues' randomised PACE trial published on March 5, this year. Full-Text PDF The PACE trial in chronic fatigue syndrome – Authors' replyThe PACE trial for patients with chronic fatigue syndrome (CFS) found that supplementation of specialist medical care with either cognitive behaviour therapy or graded exercise therapy was more effective in reducing fatigue and physical disability than was supplementation of specialist medical care with adaptive pacing therapy or specialist medical care alone. We chose patient-rated measures of fatigue and physical function as primary outcomes because this is how the disorder is defined. Full-Text PDF