Chronic fatigue patients show lower response to placebos

[Guest guest]

[interesting.... I wonder if they don't respond as well as others to

homeopathy too]

 

Public release date: 22-Mar-2005

http://www.eurekalert.org/pub_releases/2005-03/cfta-cfp031705.php

 

Contact: Dr. Hyong Jin Cho

h.cho

Center for the Advancement of Health

Chronic fatigue patients show lower response to placebos

 

Contrary to conventional wisdom, patients with chronic fatigue syndrome

respond to placebos at a lower rate than people with many other illnesses,

according to the first systematic review of the topic.

 

According to the new analysis by Dr. Hyong Jin Cho of King's College London

and colleagues, 19.6 percent of patients with chronic fatigue syndrome

improved after receiving inactive treatments, compared with a widely

accepted figure of about 30 percent for other conditions.

 

Because the placebo effect seems to be strongest in diseases with highly

subjective symptoms, some medical professionals believed it could be as

high as 50 percent among CFS patients.

 

The review, reported in the current issue of Psychosomatic Medicine, pooled

data from 29 studies in which 1,016 people with CFS received various placebos.

 

CFS is a complex illness that has no known cause or cure. Myriad symptoms

include severe malaise, muscle and joint pain, sleep and mood disturbances

and headache. The symptoms continue for at least six months and cannot be

explained by any other medical conditions. The Centers for Disease Control

and Prevention estimate that as many as 500,000 Americans may have CFS or

related conditions.

 

With so many mysteries surrounding CFS, a great deal of controversy exists

among both doctors and patients as to whether its origins are primarily

psychological or physiological. Current evidence suggests that emotional or

social stresses such as bereavement or problems at work, combined with

other triggers such as common viral infections, contribute to the disorder.

Additional factors, such as avoidance of physical activity, may cause the

symptoms to become chronic, says Cho.

 

The authors propose several possible explanations for the surprisingly low

placebo response revealed in the analysis. Perhaps patients have low

expectations due to the reality that CFS is very difficult to treat and

often persists for many years. Alternatively, disconnects between how

patients and doctors view the illness " may impede development of a

collaborative therapeutic relationship, " reviewers suggest.

 

The study also showed that the placebo response is 24 percent for medical

interventions but only 14 percent for psychiatric/psychological treatments.

The authors say the reason may be that many CFS sufferers seen in

specialist settings or self-help groups " have a firm conviction that their

illness is of physical origin " and thus would have little faith in

psychiatric/psychological treatments. This finding supports the idea that

the placebo response is greatly influenced by patients' expectations of

improvement.

 

According to the review, behavioral therapy and graded exercise therapy

have benefits, and if patients were more aware of them, says Cho, they

might be " more open, more optimistic, and more collaborative with the

professionals, and the overall outcome of the treatments could be enhanced. "

 

Dr. Lucinda Bateman, an internist who specializes in CFS and fibromyalgia

and serves on the board of the American Association for Chronic Fatigue

Syndrome, has worked with about 500 CFS patients over the past 15 years.

 

" In my clinical experience, I have found that CFS is among the most

difficult conditions to improve at all, with either physical or

psychological interventions. " This is true in part, she says, because there

is a great deal of variation among patients diagnosed with CFS, and Bateman

believes that ultimately CFS may be found to involve more than one disease.

 

In the absence of a cure, Bateman has found that the most effective

treatment for CFS combines improving symptoms with medication, helping

patients retain physical conditioning when possible and using psychological

and psychiatric interventions to help patients adapt to living with chronic

illness.

 

She doesn't discount the placebo effect, however. " When you say to people,

'I believe you, I will help you manage your symptoms, I will advocate for

you,' that hope and feeling of control over their disease could be

considered placebo effect, but it's an important part of delivering medical

care. "

 

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FOR MORE INFORMATION

 

Health Behavior News Service: 202-387-2829 or www.hbns.com Interviews:

Contact Dr. Hyong Jin Cho at h.cho

Psychosomatic Medicine: Contact Victoria White at 352-376-1611, ext. 5300, or

psychosomatic. Online, visit www.psychosomaticmedicine

 

By Laura Kennedy, Contributing Writer

Health Behavior News Service