The PACE trial – what does it mean for CFS/ME?

Chronic Fatigue Syndrome (CFS) – also referred to as Myalgic encephalomyelitis (ME) – affects 250,000 individuals in the UK. Sufferers experience profound physical and mental fatigue leaving them unable to work or function at home, school or college. There is no medical treatment for CFS or ME, and little is known about its causes. This means that treatment is predominately focused on helping sufferers manage symptoms.

In 2005, a large UK trial – PACE – examined what treatment provides the best help for managing symptoms in patients with CFS or ME. Four treatments were compared across 640 participants: Specialised Medical Care (SMC), Cognitive Behavioural Therapy (CBT) with SMC, Graded Exercise Therapy (GET) with SMC, and Adaptive Pacing Therapy (APT) with SMC.

SMC involved giving the patients specialised medical advice about their condition and symptoms along with prescribed medication to help alleviate their symptoms, for example, medication for insomnia and pain were prescribed.

Those who underwent treatment with CBT and SMC received the same medical advice alongside regular sessions with a CBT therapist who helped the patient understand how negative mental attitude and behaviour affects their physical symptoms. They were also encouraged to engage in a regular exercise program. Those in the trial who received GET with SMC were helped to gradually increase the level and intensity of their activity within their specific circumstances. Patients who had a program of APT with SMC were helped to match the level of their activity to the level of their energy. This form of treatment is focused on adapting to the illness, rather than overcoming it.

Initial results of the PACE trial showed that CBT with SMC, and GET with SMC, were 3 times more likely to successfully reduce CFS symptoms. After one year, 22% of patients in the trial using CBT and GET had recovered.

Professor Michael Sharpe the co-principal investigator in the trial from the University of Oxford, noted; “The analysis of the PACE trial shows that not only do they [CBT and GET] achieve improvements in the majority, but they can also lead to effective recovery in a substantial minority.”

Professor Trudie Chalder from King’s College London noted regarding the trial, “The fact that people can recover from chronic fatigue syndrome is excellent news.” While more research is required, the PACE trial has demonstrated that the symptoms of CFS/ME are manageable by two forms of therapy alongside SMC, and, for many recovery is possible.

This trial supports the NICE guidelines already in place for CFS/ME: “Cognitive Behavioural Therapy (CBT) and/or graded exercise therapy (GET) should be offered to people with mild or moderate CFS/ME…because currently these are the interventions for which there is the clearest research evidence of benefit.” Professor Chalder added, “Healthcare professionals can now be more confident in sharing this possibility [of recovery] with patients, many of whom are understandably concerned about their future.”

For more information on the PACE trial, see www.pacetrial.org.

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