Response to Irish Medical Times

Response to Irish Medical Times

Cognitive behavioural therapy not harmful in chronic fatigue

The PACE Trial had nothing to do with ME . ME is a WHO classified neurological disease (ICD -10-G93.3). Page 188 of the PACE Trial Protocol states that neurological disturbances “are not necessary to make the diagnosis” . The Oxford criteria upon which the PACE and FINE trials were based specifically excludes those with neurological disorders.
The PACE Trial conflated two diseases that the WHO categorises separately – neurological ‘ME/PVFS’ (ICD-10-G93.3) and psychiatric ‘Fatigue Syndrome’ (ICD-10-F.48.0) – and misrepresented the latter as the former. 
The goal of the PACE trial was to “was to change the behavioural and cognitive factors assumed to be responsible for perpetuation of the participant’s symptoms and disability.” A feature of the Trial is how no biological measures were reported. Studies of CBT in other conditions including HIV/AIDS and cardiovascular disease, routinely collect data on immune markers or other biological measures in attempt to understand how and why CBT works in the context of the condition studied. In fact the word”biology” is not mentioned even once .
The Trial did not conclude that Cognitive Behaviour Therapy (CBT)/Graded Exercise Therapy(GET) /PACING were cures for CFS or even ‘effective’ treatments for it; they said they were ‘only moderately effective’, a decidedly weak assessment of its effects.
 It is also important to stress that almost two thirds of PACE Trial participants received minimal or negative benefits from the CBT.
None of the PACE Trial interventions enabled participants to achieve anything like a normal walking speed for the full six minutes when compared with a healthy individual. The only reported improvement on the six minute level walking test for those allocated to CBT was an increase of 21 steps; these improvements cost the UK £5 million .
If the objective was to get patients well -and the stated objective was to remove the factors that perpetuated their symptoms (ie that caused their condition) – the trial failed spectacularly, for none of the PACE Trial treatments returned the participants to health or even close to it.
It is incredibly important to stress that the thesis that ME results from deconditioning or fear avoidance or negative thoughts was not borne out by this study.
References :
Action for ME PACE: “surprising and disappointing”18 February 2011
Margaret Williams ME/CFS: Terminology: 27 April 2009May 1, 2009
Cort Johnson A Hitch in its Step: PACE Trial Indicates CBT/GET No Cure For CFS, 60% of Patients Show No Significant Effects. Phoenix Rising
Professor Hooper’s Initial Response to the MRC PACE Trial Press Release hosted by The Lancet 17th February 2011
CFIDS Association of America Falling Off the PACE Analysis of the Lancet study
Anglia ME Action Collective International Professional Response to PACE Required?


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