Response: Sharpe, Goldsmith and Chalder fail to restore confidence in the PACE trial findings

Wilshire, Carolyn E.; Kindlon, Tom

doi:10.1186/s40359-019-0296-x

Cited by 6 publications

(3 citation statements)

References 21 publications

(39 reference statements)

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“…Systematic reviews have investigated the effectiveness of several ME/CFS treatments [231,232]. Cognitive behavior therapy (CBT) and graded exercise therapy (GET) are some of the few interventions that are proposed as beneficial in improving quality of life [233], but these remain controversial and have been recently criticized by others [234].…”

Section: Discussionmentioning

confidence: 99%

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review

et al. 2019

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Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating chronic disease of unknown aetiology that is recognized by the World Health Organization (WHO) and the United States Center for Disease Control and Prevention (US CDC) as a disorder of the brain. The disease predominantly affects adults, with a peak age of onset of between 20 and 45 years with a female to male ratio of 3:1. Although the clinical features of the disease have been well established within diagnostic criteria, the diagnosis of ME/CFS is still of exclusion, meaning that other medical conditions must be ruled out. The pathophysiological mechanisms are unclear but the neuro-immuno-endocrinological pattern of CFS patients gleaned from various studies indicates that these three pillars may be the key point to understand the complexity of the disease. At the moment, there are no specific pharmacological therapies to treat the disease, but several studies’ aims and therapeutic approaches have been described in order to benefit patients’ prognosis, symptomatology relief, and the recovery of pre-existing function. This review presents a pathophysiological approach to understanding the essential concepts of ME/CFS, with an emphasis on the population, clinical, and genetic concepts associated with ME/CFS.

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Section: Discussionmentioning

confidence: 99%

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review

et al. 2019

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“…However, there were specific flaws identified in this paper. Without any clear rationale, the study outcome measures were purposefully modified midtrial to alter the findings in favour of their hypothesis ( 549 , 550 ). Additionally, patients could worsen during the study and still be classified as “recovered” and the study was unblinded with subjective outcomes.…”

Section: Management Of Me/cfsmentioning

confidence: 99%

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: the biology of a neglected disease

Arron,

Marsh,

Kell

et al. 2024

Front. Immunol.

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Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a chronic, debilitating disease characterised by a wide range of symptoms that severely impact all aspects of life. Despite its significant prevalence, ME/CFS remains one of the most understudied and misunderstood conditions in modern medicine. ME/CFS lacks standardised diagnostic criteria owing to variations in both inclusion and exclusion criteria across different diagnostic guidelines, and furthermore, there are currently no effective treatments available. Moving beyond the traditional fragmented perspectives that have limited our understanding and management of the disease, our analysis of current information on ME/CFS represents a significant paradigm shift by synthesising the disease’s multifactorial origins into a cohesive model. We discuss how ME/CFS emerges from an intricate web of genetic vulnerabilities and environmental triggers, notably viral infections, leading to a complex series of pathological responses including immune dysregulation, chronic inflammation, gut dysbiosis, and metabolic disturbances. This comprehensive model not only advances our understanding of ME/CFS’s pathophysiology but also opens new avenues for research and potential therapeutic strategies. By integrating these disparate elements, our work emphasises the necessity of a holistic approach to diagnosing, researching, and treating ME/CFS, urging the scientific community to reconsider the disease’s complexity and the multifaceted approach required for its study and management.

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“…Exercise appears to exert a moderate effect on fatigue in people with CFS in the short term [17]. However, following a reanalysis of an influential study [18,19] and subsequent controversy [20,21], the CDC no longer recommends graded exercise (progressive aerobic activity) as a recommended therapy in ME/CFS [14]. However, in people living with and beyond cancer, exercise (including moderate-vigorous exercise) is considered a safe and effective intervention to counteract the adverse physical and psychological effects of cancer and its treatment [22,23], including CRF (e.g.…”

Section: Introductionmentioning

confidence: 99%

Post-Exertional Malaise in People with Chronic Cancer-Related Fatigue

Twomey

Yeung

Wrightson³

et al. 2019

Preprint

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Context: Cancer-related fatigue (CRF) is a distressing and persistent sense of tiredness or exhaustion that interferes with usual functioning. Chronic CRF continues for months after curative cancer treatment is complete. Post-exertional malaise (PEM) is a worsening of symptoms after physical or mental activity, with limited investigations in people with chronic CRF. Objectives: The purpose of this study was to identify and describe self-reported incidences of PEM in people with chronic CRF. Methods: Participants (n=18) were eligible if they scored ≤34 on the Functional Assessment of Chronic Illness Therapy-Fatigue scale and had a cancer-related onset of fatigue. Participants completed a brief questionnaire to assess PEM over a 6-month time-frame (the DePaul Symptom Questionnaire - Post-Exertional Malaise; DSQ-PEM). In addition, a maximal exercise test was used to investigate self-reported symptom exacerbation (via an open-ended questionnaire) after strenuous physical exertion. Results: On the DSQ-PEM, three participants met previously defined scoring criteria, which included experiencing moderate to very severe symptoms at least half of the time, worsening of fatigue after minimal effort, plus a recovery duration of >24 h. Content analysis of responses to open-ended questionnaires identified five people who experienced a delayed recovery and symptoms of PEM after maximal exercise. Conclusion: A subset of people with chronic CRF (up to 33% in this sample) may experience PEM. Exercise specialists and health care professionals working with people with chronic CRF must be aware that PEM may be an issue. Symptom exacerbation after exercise should be monitored, and exercise should be tailored and adapted to limit the potential for harm.

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Response: Sharpe, Goldsmith and Chalder fail to restore confidence in the PACE trial findings

Cited by 6 publications

References 21 publications

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: the biology of a neglected disease

Post-Exertional Malaise in People with Chronic Cancer-Related Fatigue

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