Chronic fatigue syndrome

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

Chronic fatigue syndrome (CFS) is characterised by severe, disabling fatigue and other symptoms, including musculoskeletal pain, sleep disturbance, impaired concentration, and headaches. The two most widely used definitions of CFS are from the Centers for Disease Control and Prevention (CDC) and the Oxford criteria. The principal difference between these definitions is the number and severity of symptoms, other than fatigue, that must be present.

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Focus of the review

There are a wide range of treatments that have been proposed for CFS, most of which have little or poor evidence base and which have been extensively considered in the previous version of this BMJ Clinical Evidence systematic overview. For this update, the focus was on treatments that had the best evidential support in previous editions, that are in widespread clinical use, and/or have recent trial data.

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Comments on evidence

There is good-quality evidence that both cognitive behavioural therapy (CBT) and graded exercise therapy are effective treatments for reducing fatigue and increasing functional capacity in people with CFS. There is less evidence for the drug treatments considered in this overview (antidepressants and corticosteroids); in particular, the evidence for corticosteroid use in people with CFS is limited. Several different instruments were used across studies to measure our outcomes of interest. Some of these involved self-rating by the person with CFS, whereas others report clinician-rated outcomes (in which case the assessor should be blinded). We have not reported school attendance as a main outcome in this overview, however, if available, we have added this data to the relevant Further information on studies section. Most studies were quite short-term; we only found one study with follow-up beyond 12 months.

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Search and appraisal summary

The update literature search for this overview was carried out from the date of the last search, March 2010, to November 2013. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 169 studies. After deduplication and removal of conference abstracts, 86 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 71 studies and the further review of 15 full publications. Of the 15 full articles evaluated, two systematic reviews, one RCT, and one further follow-up report of an RCT were added at this update.

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Additional information

The largest RCT to date found that CBT and graded exercise therapy are more effective than adaptive pacing therapy or specialised medical care. While antidepressants may not be effective for CFS per se, they should be considered for patients with depressive disorders. Tricyclic antidepressants, in particular, should be considered in patients with chronic joint and/or muscle pain given their additional analgesic properties.

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Substantive changes at this update

Cognitive behavioural therapy Two systematic reviews,[34][35] one RCT,[46] and a further longer term follow-up report added.[45] Categorisation unchanged (beneficial).

Graded exercise therapy Two systematic reviews [34][35] and one RCT added.[46] Categorisation unchanged (beneficial).

Abstract

INTRODUCTION: Chronic fatigue syndrome affects between 0.006% and 3% of the population depending on the criteria of definition used, with women being at higher risk than men. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of selected treatments for chronic fatigue syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). RESULTS: At this update, searching of electronic databases retrieved 169 studies. After deduplication and removal of conference abstracts, 86 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 71 studies and the further review of 15 full publications. Of the 15 full articles evaluated, two systematic reviews, one RCT, and one further follow-up report of an RCT were added at this update. We performed a GRADE evaluation for 23 PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the effectiveness of four interventions based on information relating to the effectiveness and safety of antidepressants, cognitive behavioural therapy, corticosteroids, and graded exercise therapy.

Cite as

Cleare AJ, Reid S, Chalder T, Hotopf M, Wessely S. Chronic fatigue syndrome. Systematic review 1101. BMJ Clinical Evidence. . 2015 September. Accessed [date].

Latest citations

Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Evidence Report/Technology Assessment No. 219. ( 02 February 2016 )

Exercise therapy for chronic fatigue syndrome. ( 02 February 2016 )