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 mana
'"/>

Contact: Dr. Hyong Jin Cho
h.cho@cop.kcl.ac.uk
Center for the Advancement of Health
22-Mar-2005