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Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial

Published online by Cambridge University Press:  23 August 2013

J. H. Bourke ,
A. L. Johnson ,
M. Sharpe ,
T. Chalder  and
P. D. White
J. H. Bourke*
Affiliation:
Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
A. L. Johnson
Affiliation:
MRC Biostatistics Unit, University of Cambridge Institute of Public Health MRC Clinical Trials Unit, London, UK
M. Sharpe
Affiliation:
Department of Psychiatry, University of Oxford, Oxford, UK
T. Chalder
Affiliation:
Academic Department of Psychological Medicine, King's College London, UK
P. D. White
Affiliation:
Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
*
* Address for correspondence: Dr J. H. Bourke, Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Dominion House, 59 Bartholomew Close, London EC1A 7ED, UK. (Email: [email protected])
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Abstract

Background

Pain is a common symptom of chronic fatigue syndrome (CFS). We investigated the effects of the treatments used in the PACE trial [cognitive behavioural therapy (CBT), graded exercise therapy (GET), adaptive pacing therapy (APT) and specialist medical care (SMC)] on pain in CFS.

Method

We compared pain outcomes including individual painful symptoms, taken from the CDC criteria for CFS and co-morbid fibromyalgia. We modelled outcomes adjusting for baseline variables with multiple linear regression.

Results

Significantly less frequent muscle pain was reported by patients following treatment with CBT compared to SMC (mean difference = 0.38 unit change in frequency, p = 0.02), GET versus SMC (0.42, p = 0.01) and GET versus APT (0.37, p = 0.01). Significantly less joint pain was reported following CBT versus APT (0.35, p = 0.02) and GET versus APT (0.36, p = 0.02). Co-morbid fibromyalgia was less frequent following GET versus SMC (0.03, p = 0.03). The effect sizes of these differences varied between 0.25 and 0.31 for muscle pain and 0.24 and 0.26 for joint pain. Treatment effects on pain were independent of ‘change in fatigue’.

Conclusions

CBT and GET were more effective in reducing the frequency of both muscle and joint pain than APT and SMC. When compared to SMC, GET also reduced the frequency of co-morbid fibromyalgia; the size of this effect on pain was small.

Keywords

Adaptive pacing therapy (APT)chronic fatigue syndrome (CFS)chronic paincognitive behavioural therapy (CBT)fibromyalgiagraded exercise therapy (GET)PACE trialrehabilitation
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 7 , May 2014 , pp. 1545 - 1552
Copyright
Copyright © Cambridge University Press 2013 

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