Chronic fatigue syndrome and long covid: moving beyond the controversy

Abstract

Chronic fatigue syndrome and long covid: moving beyond the controversy Many patients with "long" covid are experiencing extreme fatigue, a situation that has re-polarised approaches to treatment and rehabilitation. Melanie Newman reports Melanie Newman freelance journalist "I submitted the first positive trial of cognitive behavioural therapy [CBT] as a treatment for chronic fatigue in the '90s," recalls Michael Sharpe, a professor of psychological medicine who was then a lecturer at Oxford University. "Next thing, my head of department got an unsigned letter, sent to The BMJ, saying that the research study was made up."

Chronic fatigue syndrome and long covid: individualisation, not compartmentalisation

“…Newman’s investigation of chronic fatigue syndrome and long covid supports the development of specialised multidisciplinary support for patients with long covid 1. But compartmentalisation of a problem like chronic fatigue syndrome can sometimes miss the point.…”

Long covid: reshaping conversations about medically unexplained symptoms

“…Newman’s article, a linked patient commentary, and the tranche of rapid responses show how “long covid” has reignited debate about the causes and management of chronic fatigue syndrome 1. Rather than moving beyond the controversy, most of the ensuing arguments have fallen back into familiar grooves deepened by confirmation bias and dualistic thinking 123.…”

“…Newman’s article, a linked patient commentary, and the tranche of rapid responses show how “long covid” has reignited debate about the causes and management of chronic fatigue syndrome 1. Rather than moving beyond the controversy, most of the ensuing arguments have fallen back into familiar grooves deepened by confirmation bias and dualistic thinking 123. On a more positive note, the intense media attention on and public interest in long covid present a golden opportunity to reshape and extend discussions about medically unexplained symptoms.…”

How can we manage covid fatigue?

“…Up to 376 000 people in the UK have reported ongoing symptoms more than 12 months after contracting the virus, with persistent mental and physical fatigue a troubling reality for many (doi:10.1136/bmj.n1559). 2 This presents clinicians with a range of challenges. Should patients with fatigue follow the dominant advice of the CFS/ME communities: that pacing rather than graded exercise therapy is the safest route, as is now also recommended in controversial draft guidance from the UK National Institute for Health and Care Excellence?…”

“…Promisingly, away from the “fire and fury” of debate, doctors and others are quietly working out how best to treat each patient without causing harm (doi:10.1136/bmj.n1559). 2 Careful screening for post-exertional malaise and individualised treatment plans seem to be the way forward. But it’s also crucial to tackle endemic power imbalances between patients and professionals and to co-produce knowledge and services (https://blogs.bmj.com/bmj/2021/06/23/how-power-imbalances-in-the-narratives-research-and-publications-around-long-covid-can-harm-patients).…”