A mysterious disease

You feel exhausted for months. You drag yourself and struggle to fulfill your daily tasks. You sleep badly and do not remember anything again ... Your doctor has not found anything? Perhaps, suffer from the "chronic fatigue syndrome". Viruses, psychological factors ... the real cause could not be identified with certainty. An Anglo-Saxon study is trying to unravel the mystery of this controversial disease.

44 medical studies screened

Viruses, anomalies of the immune system and neurohormonal, psychological factors were suspected without the true cause of this "chronic fatigue syndrome" could be identified with certainty. Now a thorough analysis of the international literature leads English and American researchers to conclude that the only effective treatments of the mysterious syndrome would be physical exercise and cognitive psychotherapies. Can we conclude from this that the disease is of psychological origin? Not so sure ...

Various strong treatments

Intense and long-lasting fatigue, insomnia, loss of memory, nocturnal sweats or headaches, joint and muscular pains ... Doctors you consulted find nothing. No viral infection like the flu, no hepatitis or mononucleosis, no neurological or muscular disorder ... Do not look. Perhaps, suffer from the "chronic fatigue syndrome", or its scientific name "myalgic encephalomyelitis". Described for the first time in the American yuppies of the late 1980s, this syndrome extends the long list of diseases whose causes are unknown.

Yes to exercise and psychotherapy!

Although the World Health Organization has recognized the existence of "chronic fatigue syndrome" which seems 2 to 3 times more common in women than in men, experts still do not agree with each other. The debate concerns mainly its determinants (physical or psychic) ​​and at least four definitions of the syndrome exist in the world. According to the Agency for Healthcare Research and Quality, it would affect between 0.04% and 2.6% of individuals and would be far from affecting only senior managers.

A bizarre disease, various treatments. As one might suspect, all kinds of therapeutics of extremely varied natures have been tried to restore punch to the "tired chronic". Two teams of English and American researchers wanted to know the truth and whether there really are ways to treat this syndrome.

To do so, they used 19 specialized medical databases, surveyed 350 studies and screened 44 of them, bringing together a total of 2,801 patients. The criteria for selecting these studies were their scientific rigor and the presence of a therapeutic component.

Their results * run counter to what was previously thought. While many patients complain of exercise fatigue, moderate exercise would have an interest in reducing this syndrome.

The same applies to cognitive psychotherapies, which reduce fatigue and improve the quality of life of patients. According to the authors, these findings do not prove that the disease is purely psychological. Even if the condition was due to a dysfunction of the body, restoring physical activity and psychological help could mitigate its consequences.

On the other hand, the benefit of medicines for immunological purposes sometimes prescribed to "chronic fatigued" has appeared uncertain even if some of these therapeutics such as immunoglobulins or corticosteroids seem to exert some effects of limited magnitude.
As for the other strategies proposed: nutritional supplements (fatty acids, liver extracts, vitamins ...), antidepressant drugs or other unconventional therapeutics (osteopathy, homeopathy, massages ...), the evidence in favor of a clinical activity Been deemed insufficient. In their discharge, however, these treatments were often evaluated only in one or two studies at most. More research is needed to assess their effectiveness.

We see it. The case is not resolved and the causes of the "chronic fatigue syndrome" are not ready to be clarified. But, the study suggests that measured physical activity and psychological support to better cope with stress and can provide more in case of intense and prolonged fatigue. It's already that ...

* JAMA (2001; 286: 1360-1368