Course and prognosis

Anecdotal reports of the prognosis of CFS make gloomy reading. What is more, systematic studies are hardly more encouraging, suggesting that the commonest outcome of those attending a specialist CFS clinic is continuing ill health, up to and beyond 5 years. (23) However, these observations need elaboration.

• The rather dispiriting prognostic studies all refer to patients seen in specialist centres. Nearly all had several years of illness prior to referral, and it is unsurprising to find that chronicity predicts chronicity. Primary care and community samples and patients appear to have a better outcome.

• Patients seen in specialist clinics often have strong views about illness aetiology and illness management that may negatively influence their acceptance of and adherence to potentially effective treatment.

• The current generation of outcome studies refer to the situation without treatment, perhaps because many suggested either that no treatment was possible or, alternatively, promoted ineffective treatments. Later sections of this chapter suggest that this view needs to be revisited.

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