Placebos provoke low response rate in chronic fatigue patients

Chronic fatigue syndrome is a near constant source of controversy among doctors. Because its effects, including sleep deprivation, joint pain, and headaches, are extremely subjective, many have claimed that it is a psychological disorder rather than a physiological one. Low placebo response rates, though, suggest that the chronic fatigue may be rooted in physiology.

• 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.
• 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.
• 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."
• 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.