The PACE trial, undertaken by Queen Mary University of London, was the largest ever trial of therapies for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). The trial aimed to test and compare the effectiveness of four of the main treatments available for people CFS/ME. These were adaptive pacing therapy, cognitive behaviour therapy (CBT), graded exercise therapy, and standardised specialist medical care (SMC).
The five-year trial involved over 600 participants, aged 18 and over, in Scotland and England. The first set of results from the trial were published in 2011 in the Lancet, and a number of other evaluations based on the trial have been published since. The trial results found both CBT and GET were moderately effective when provided alongside SMC and were better than adaptive pacing therapy or SMC alone in improving both symptoms and disability.
The National Institute for Health and Care Excellence (NICE) guideline ‘Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): Diagnosis and management of CFS/ME in adults and children’, sets outs best practice for clinicians on the diagnosis, treatment, care and support of people with the condition. The guideline recommends CBT and GET as appropriate treatments for mild to moderate CFS/ME, in line with the best available evidence.
The NICE guideline acknowledges that there is no one form of treatment to suit every patient and that treatment and care should take into account the personal needs and preferences of the patient. Decisions concerning the appropriateness of treatments should be made on a case by case basis.
On 20 September 2017, NICE announced its decision to undertake a full update of the guideline, following a review of the latest available evidence on the diagnosis and management of CFS/ME and a public consultation. New guidance is expected in October 2020. More information on this decision can be found at the following link: