Treatment of ME/CFS should target the pathophysiological aberrations

Michael Maes & Frank N.M. Twisk

Abstract
In a recent article published by B. van Houdenhove and P. Luyten it is claimed that cognitive behavioral therapy and graded exercise therapy (CBT/GET) are evidence based and are the most adequate treatments to control symptoms and improve quality of life of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

However, these authors do not disclose that their own treatments at the Belgian CFS Reference Centers with CBT/GET have proven to have no clinical effects.

The Belgian minister declared in the parliament that CBT/GET at those centers are no curative therapies.

Even more, measured by objective standards the CBT/GET approach has shown to be counterproductive. van Houdenhove and Luyten neglect or deny all scientific findings on the pathophysiology and possible medical treatments of ME/CFS.

However, there is now a consensus that inflammatory and oxidative and nitrosative (IO&NS) pathways underpin the pathophysiology of ME/CFS in humans and in animal models as well.

Human and animal data show that treatments which target IO&NS pathways are useful in treating ME/CFS. van Houdenhove and Luyten also propose that the time has come to shift treatment research in CFS from efficacy studies to effectiveness studies in ‘real life’. In our opinion, future research should use a high throughput screening, made possible by the translational approach, in order to further examine the IO&NS pathways in detail; further delineate novel drug-targets in the IO&NS pathways and develop new drugs to treat this complex and serious medical disorder.