Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?

Peter Campion

doi:10.3399/bjgp16X687229

Geraghty and Esmail have done well to draw attention to the substantial biomedical literature now extant around chronic fatigue syndrome (CFS).¹ They are right to point out that the dominant model has been a biopsychosocial (BPS) one, and that this has led to persistent disagreement between doctors and patients. What is particularly salutary is the absence of any advance in therapy, so that they recommend, for example, cognitive behavioural therapy (CBT), but with the caveat that it might not be helpful in individual cases. CFS continues to challenge GPs by its resilience to treatment, but colleagues will be well advised to take on board the changing evidence for pathophysiology set out in this article. Many of the cited papers are accessible and worth reading, such as the authors’ reference 8,² and in that paper, reference 38.³

The bottom line for me is respect for the patient, and humility in the face of lack of knowledge about the precise causes of CFS, which is clearly anyway a heterogeneous group of conditions.

REFERENCES

1.↵
1. Geraghty KJ,
2. Esmail A
(2016) Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm? Br J Gen Pract doi:10.3399/bjgp16X686473, http://bjgp.org/content/66/649/437.
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1. Twisk NM,
2. Geraghty KG
(2015) Deviant cellular and physiological responses to exercise in myalgic encephalomyelitis and chronic fatigue syndrome. J J Physiology 1(2):007.
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1. Meeus M,
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(2010) Reduced pressure pain thresholds in response to exercise in chronic fatigue syndrome but not in chronic low back pain: an experimental study. J Rehabil Med 42(9):884–890.
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