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NICE finally moves to stop recommending exercise for chronic “fatigue”

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Outstanding news:

After years of campaigning to highlight the harm people with myalgic encephalomyelitis (ME) have experienced when undergoing graded exercise therapy, MEAction UK have just received a momentous email from the National Institute for Health and Care Excellence (NICE), advising us that:

“NICE have updated the warning on the 2007 CFS/ME guideline, directing health professionals to the new draft recommendations on graded exercise therapy which explicitly state: “Do not offer people with ME/CFS any programme based on fixed incremental increases in physical activity or exercise, for example graded exercise therapy.”

Chronic “fatigue” syndrome has always been a spectacularly problematic label, because (among other reasons) it’s not really chronic “fatigue” but severe, disabling malaise. Patients with myalgic encephalomyelitis — the best known specific cause of severe chronic “fatigue” — do not just need to buck-up and exercise more, and this is probably also true of many other hard-to-diagnose causes of chronic fatigue… er, malaise!

I just linked to the good news in my discussion of this topic in my fibromyalgia guide.

Biologically stressed organisms — sick or injured — often feel nasty in roughly the same kind of way, regardless of exactly what’s wrong. That awful feeling of green-around-the-gills exhaustion and fragility is how the body enforces a “policy” of rest and recuperation. And that feeling is mainly produced with neuroinflammation, a very basic system found throughout the animal kingdom. It’s quite likely that this mechanism accounts for why several causes of chronic pain and illness seem to produce roughly the same clinical picture: because most of what the patient feels is simply the body hollering “there is something wrong, dammit!” I also discuss neuroinflammation and “sickness behaviour” in the fibromyalgia article.