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Cracking The Conundrum Of Chronic Fatigue Syndrome

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Nearly three decades have passed since the debate began about a series of symptoms that have come to be known as chronic fatigue syndrome. It's cause is still unknown, but over the years, researchers have identified various brain, immune system and energy metabolism irregularities involved. Some patients describe the syndrome as feeling like an "unrelenting, unremitting flu."

Doctors say some treatments can help. Arthur Barsky, a psychiatrist at Brigham and Women's Hospital in Boston and a professor at Harvard Medical School, says patients need to change how they experience symptoms — typically pain, insomnia and anxiety. When patients adopt a more positive attitude, Barsky points out, it often translates into greater confidence and more energy.

A study published this year in The Lancet found that a form of talk therapy, as well as exercise, offered relief for some patients. Researchers from the United Kingdom looked at cognitive behavior therapy, or CBT.

In the study, over 600 patients with chronic fatigue syndrome were assigned to different treatments. All of them received medical care for symptoms like pain, insomnia or anxiety.

One group got counseled about how to pace activities. Another took part in an exercise program. And a third received the cognitive behavioral talk therapy. The therapy and the exercise group improved the most, reporting less fatigue, insomnia and anxiety.

Barsky says his patients do best when cognitive behavior therapy is also combined with gradually increased exercise. "People need to begin to push themselves in the face of their fatigue, because if you don't, you become deconditioned and you get caught in a cycle which ... makes fatigue worse," says Barsky.

But he cautions against overdoing it. People should start with mild, gentle exercise like clearing the table, doing the dishes, or taking the dog for a short walk. Then, slowly build up to longer and more frequent walks, he says.

Lucinda Bateman is a doctor at the Fatigue Consultation Clinic in Salt Lake City who specializes in chronic fatigue syndrome.

She's skeptical about the Lancet study, pointing out that patients improved only moderately, and not much more than those who were counseled about pacing themselves. Bateman suggests her patients pace themselves, and try to do only as many activities as they can manage.

She says some patients get caught in a "push and crash" cycle. When symptoms abate and they feel better, they may go all out, exercising, doing errands and socializing. But soon that level of activity often comes to a crashing end and patients can relapse dramatically, even becoming bedridden for several days or longer.

Bateman takes also issue with CBT's implication that chronic fatigue syndrome is psychosomatic. We still don't know what exactly causes the syndrome. And, like most professionals who treat patients, Bateman eagerly awaits the day when science can finally pinpoint its cause.

With additional reporting from Joanne Silberner

Copyright 2011 National Public Radio. To see more, visit http://www.npr.org/.

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