Wait six months before treating fatigue, GPs told
GPs should advise patients with chronic fatigue to wait and see if their tiredness resolves itself with six months, recommend UK researchers who looked at the time course of symptoms.
NICE guidelines currently advise treatment for chronic fatigue syndrome after four months of symptoms, but this trial in 222 patients found fatigue can ‘improve substantially' within six months and should be left alone.
The researchers studied patients reporting fatigue for over three months to their GP, and randomised them to 'usual care' – providing a booklet describing causes of fatigue and self-help techniques based on cognitive behavioural therapy – or NICE-approved therapies such as counselling and graded exercise.
They found fatigue symptoms in patients treated with graded exercise therapy or counselling were no better during this time than those who had been managed with usual care. Of the 222 participants, those who were given the CBT booklet had a reduction in mean Chalder fatigue score at six months of 8.1, compared with 10.1 for those using graded exercise therapy and 8.6 for counselling.
A mixed multiple linear regression analysis showed that there was a mean improvement in the Chalder fatigue score over time – of 9.2 between baseline and six months – regardless of which treatment group patients were in. The improvement between six month and 12 month follow-up was not significantly different between those receiving usual care and those receiving either graded exercise therapy or counselling.
In general, dissatisfaction with care was high. But there was no significant difference between the three groups at six months - with 57.3% of the booklet group reporting that they were either very, moderately or slightly dissatisfied, compared with 60.6% of the graded exercise group and 61.8% of the counselling group. However, there was a difference in dissatisfaction between groups at 12 months, with those in the booklet group being more dissatisfied (65.3%, 52.1% and 54% respectively).
Study lead, Professor Leone Ridsdale, professor of neurology and general practice at King's College London,said: ‘Our findings suggest that many patients improve substantially in the first six months.'
‘From the current evidence, we propose that after assessment of patients who present with fatigue in primary care, doctors offer to reassess them in six months. If fatigue symptoms persist, the practitioner and patient may discuss further therapy options.'
Change in fatigue scores at six months
Usual care – 8.1
Graded exercise therapy -10.1
Psychological Medicine 2012, published online28 February