Chronic fatigue conditions are not incurable

A recent overview of all relevant research demonstrates that cognitive behavioural therapy (CBT) and physical therapy interventions are effective for so-called 'Long Covid.' At the same time, there is no compelling evidence that any medication or supplements, vitamins, or hyperbaric oxygen are of benefit.

We at the Oslo Chronic Fatigue Network — a European professional network of researchers and clinicians (some of whom are former patients) — advocate for a holistic approach to chronic fatigue conditions such as 'Long Covid,' ME/CFS, and burnout. 

This understanding is grounded in recent research and offers hope to those suffering from these conditions. These illnesses can be severe, often causing individuals to drop out of school or work, which leads to personal suffering, distress, and substantial societal costs. 

We believe it is possible for people to get better, and even fully recover, from prolonged fatigue conditions and associated symptoms.

Biological, psychological, and social factors

Despite over 40 years of research on chronic fatigue syndromes like CFS/ME, no specific biological cause has been identified. Research has shown that persistent infections or other bodily diseases cannot explain the symptoms of these conditions. 

Therefore, it is reasonable to view these syndromes through a broader framework that integrates biological, psychological, and social factors. Such an approach may pave the way for more effective treatment strategies.

Symptoms on a spectrum

We seek to challenge the widespread perception that chronic fatigue conditions are incurable. Diagnoses such as CFS/ME, post-Covid-19 syndrome, and burnout can be useful for describing symptoms but may also hinder recovery. 

By viewing symptoms on a spectrum – recognising varying degrees of the same symptoms seen in different conditions - we can better understand these conditions and the unique needs of each patient. This approach will improve diagnostics, treatment, and support for those living with these challenges.

Symptoms in an alarm system

We acknowledge that the symptoms associated with these fatigue conditions are real, leading to significant suffering and functional impairment. Like all sensory experiences, these symptoms arise from synchronised activity in complex neural networks in the brain. 

While such activity can be triggered by signals stemming from bodily injuries, it can also occur in the absence of physical harm or disease. Symptoms reflect the brain’s response to a complex interplay of biological, psychological, and social factors rather than a specific disease process.

From an evolutionary perspective, fatigue and pain are the brain's responses to perceived threats - part of an alarm system that serves as an essential survival mechanism. These alarms are typically temporary and adaptive. 

However, sometimes the alarm becomes stuck in a persistent state, as seen in certain long-lasting pain conditions. This understanding can help explain why symptoms occur and, in some cases, persist.

The body does not function like a battery

We challenge the practice of prolonged rest and sensory or social isolation (known as shielding) as a way to manage chronic fatigue conditions. While rest may help initially, a gradual increase in activity helps people recover. 

Persistent symptoms should be viewed as sensory signals that can be interpreted in various ways, rather than as automatic evidence of injury or energy depletion. The human body does not operate like a battery that simply runs out or needs recharging. 

We advocate for incorporating cognitive, behavioural, and stress-reducing strategies into treatment to help patients alleviate symptoms, improve functioning, and enhance quality of life.

Listen to the patients in open dialogue

The patient perspective is important. We can learn from people who have experienced improvement or recovered. 

Stories from individuals who have benefited from cognitive, behavioural, or stress-reducing strategies can offer unique insights—not only into the experience of being ill but also into the paths toward recovery. 

We encourage open dialogue and discussion about the understanding and treatment of chronic fatigue conditions.

Conclusion

We strongly advocate for raising awareness that improvement and recovery are possible for individuals living with chronic fatigue conditions. 

This belief is grounded in extensive research, clinical experience, and the perspectives of patients who have experienced positive changes and full recovery. Our goal is to bring justified hope and optimism to everyone affected by these conditions.

In summary, we need to foster a broader, more constructive, and better-informed public debate about these disabling conditions. Only then can we make genuine progress in supporting those who suffer. 

This new research provdes evidence for treatments that will help people recover, and is consistent with the approach the Oslo Networks understanding of these conditions.

The article is signed by the following board members of the Oslo Chronic Fatigue Network:

• Silje Endresen Reme, Professor at Department of Psychology, University of Oslo
• Helena Liira, Chief Physician in Primary Health Care, Hospital District of Helsinki and Uusimaa (HUS)
• Michael Sharpe, Professor emeritus of psychological medicine, Oxford University
• Markku Sainio, Clinic for persistent somatic symptoms, Hospital District of Helsinki and Uusimaa (HUS)
• Trudie Chalder, Professor of Cognitive and Behavioral Therapy, Kings College
• Paul Garner, Professor Emeritus, Liverpool School of Tropical Medicine
• Charlotte Ulrikka Rask, Clinical Professor at Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry

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