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Row over therapy call for CFS

By Emma Wilkinson

NICE guidance on diagnosing and managing chronic fatigue syndrome has reignited a long-running controversy over the root cause of the illness by advising treatment with psychological therapies.

The guidance calls for PCTs to provide cognitive behaviour therapy and exercise treatments among other treatment options – and should give ammunition to GPs battling to help patients with the condition.

In addition to recommendations that severely affected people should get specialist help at home, NICE says CBT and graded exercise therapy should be offered for mild to moderate CFS/ME – to criticism from an ME patient group.

Action for ME said the recommendations placed 'undue emphasis' on psychological and physical therapies and criticised the failure of the guidance to recognise CFS as a neurological disorder.

NICE says a diagnosis of ME should be made after four months of symptoms with no other apparent cause in adults and three months in children.

GPs are also given recommendations for giving advice on managing activity, rest periods, sleep patterns, diet, assessing fitness to work and effects on education.

Children with symptoms of ME should be referred to a paediatrician within six weeks, according to NICE.

Professor Peter White, professor of psychological medicine at Queen Mary's School of Medicine and Dentistry in London, said on the basis of current evidence there was no alternative to psychological and physical treatment.

'The guidelines are a major step forward and provide for the first time reliable advice and information for GPs.

'The major issue has not been how to treat it, it's been that patients can't get the treatment because there's no CBT or physiotherapy available in vast areas of the country.'

GP academic Professor Richard Baker, chair of the guideline development group and head of the Department of Health Sciences at the University of Leicester, said:

'Care for people with ME has varied wildly and in some cases has left people feeling their illness isn't recognised by the healthcare system.'

Symptoms of CFS/ME

• Debilitating fatigue brought on by minimal activity
• Malaise
• Headaches
• Sleep disturbances
• Difficulties with concentration
• Muscle pain

Symptoms vary and may fluctuate in intensity and severity.

Source: NICE

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