Chronic Fatigue Patients Show Lower Response To Placebos article

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Chronic Fatigue Patients Show Lower Response To Placebos

Date: 2005-04-21

http://www.sciencedaily.com/releases/2005/04/050420090825.htm

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. "