What is the standard NHS Treatment for Chronic Fatigue Syndrome?
See the three standard treatments the NHS currently offers for CFS below. I discuss graded exercise therapy (GET), CBT and medication.
Graded Exercise Therapy (GET)
GET is a structured exercise programme that aims to gradually increase your physical activity levels and usually involves exercises that increase heart rate, such as walking or swimming. Once activity levels have been established, a healthcare professional will work to set goals to increase the intensity and duration of exercise moving forwards. This happens irrespective of patient feedback, even if they feel worse following exercise.
This therapy gained momentum because of a 2011 study funded by the UK Medical Research Council, called the PACE trial. Conducted on 641 patients, PACE was one of the largest randomised trials for CFS, examining interventions such as CBT and GET. Results were published in the Lancet, suggesting that a full recovery from CFS was possible following these interventions, so justifying the NHS’s recommendation for CBT and GET for patients.
However, the PACE trial and, in particular, GET have faced harsh criticism from patients, clinicians, researchers and CFS charities alike, following numerous reports that GET was making patients’ CFS much worse. An independent survey7 of CFS patients was commissioned by Forward-ME in 2019, to feed into the NICE guideline review process, which found that 81 per cent of patients’ symptoms worsened after receiving GET. One of the criticisms is that physical activity is increased regardless of how the patient is feeling, often ignoring an increase in (or onset of new) symptoms.
As a result of the criticism, NICE updated their guidelines in 2021, moving away from recommending GET as a therapy for CFS, which is a fantastic step forward.
2. CBT
CBT is a form of talking therapy that works to support changes in the way people think and behave. It is used in the management of anxiety, depression, eating disorders and IBS, as well as CFS. CBT is based on the concept that your thoughts, feelings, physical sensations and actions are all interconnected, and that negative ways of thinking keep you trapped in a vicious cycle.
In a CBT session, you work with a therapist to break down your problems into parts, such as thoughts, physical feelings and actions, establishing whether they are helpful or unhelpful to you, and considering steps that may be necessary to change them.
There is some conflicting data when it comes to CBT and patient outcomes in CFS. Some patients have reported a worsening of their symptoms following CBT, whereas others have experienced little change or a significant improvement in symptoms. Some experts think that for those who experience a worsening of their condition following CBT it may be because they feel that their illness is being psychologised. I would be inclined to agree. I often find that when CFS patients understand that their condition is physical but can be supported by psychological therapies, CBT can provide numerous benefits to their health.
3. Medication
There is no specific medicine for CFS. However, there are medicines that can help to relieve symptoms. Over-the-counter painkillers can be used to ease headaches and muscle and joint pain, while some GPs might prescribe antidepressants for those with chronic pain or trouble sleeping.
Would love to hear your thoughts in the comments below!
Lauren x