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Archived Comments for: Use of medications by people with chronic fatigue syndrome and healthy persons: a population-based study of fatiguing illness in Georgia

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  1. Differences in medication usage in the Wichita and Georgia cohorts could be due to the different methods of operationalizing the Fukuda criteria that were used

    Tom Kindlon, Irish ME/CFS Association - for Information, Support & Research

    4 December 2009

    Medication usage was not the same in the CFS populations found in the Wichita and Georgia populations.

    The authors summarise the similarities and differences in the following paragraph:

    “Our findings confirm those from a previous study of medication use in persons with CFS from Wichita, Kansas. Both studies found significantly higher usage of pain relievers, gastrointestinal drugs, antidepressants and benzodiazepines by persons with CFS compared to Well controls. Unlike the Wichita study, though, persons with CFS in Georgia were not significantly more likely than controls to use hormones and supplements but were significantly more likely than controls to use muscle relaxants and anti-allergy and cold/sinus medications. Overall, compared to persons with CFS from the Wichita study7, a smaller proportion of persons with CFS in Georgia used pain-relievers (65.5% in Georgia vs. 87.8% in Wichita), supplements/vitamins (44.3% vs. 62.2%), antidepressants (36.3% vs. 41.1%), antibiotics (7.1% vs. 16.7%), hormones (43.4% vs. 52.5%. among women only, 11.8% among all CFS), antihypertensive drugs (17.7% vs. 21.1%), muscle relaxants (8.9% vs. 12.2%), anti-asthma medications (7.1% vs. 12.2%), glucose-lowering drugs (0.9% vs. 4.4%.). Use of other prescription drug categories such as lipid-lowering drugs (11.5% vs.12.2%) and benzodiazepines (12.4%, vs. 11.1% respectively) was similar in Georgia and Wichita (Kansas). The relatively lower usage of most prescription drug medications by persons with CFS in Georgia compared to Wichita may reflect lower seeking of, or lower access to, health care.”

    An alternative reason could be that the two sets of criteria for CFS used were not selecting the same type of patients.

    The current study[1] uses the empiric definition for CFS[2]. As one can see from the paper that gives the criteria involved in the empiric definition, although it is also based on the Fukuda definition[3], a different number of patients satisfy the criteria [2] compared to how the authors used the definition in the initial study of the Wichita population.

    This change looks more significant when one looks at the prevalence rates for CFS obtained in the two cohorts. In the Wichita study[4], the prevalence of CFS was 0.235% (95% confidence interval, 0.142%-0.327%). In the Georgia study[5], the prevalence of CFS was 2.54%, 10.8 times the prevalence in the Wichita study!

    Concerns have been raised[6,7] about the newer method[2] of operationalizing the Fukuda definition[3] that were used in the current study[1]. In the only study[7] using the empiric criteria [2] that I am aware of that did not involve the CDC CFS team, 38% of those chosen as patients with Major Depressive Disorder but not CFS, were found to satisfy the new criteria[2] for CFS.


    1] Boneva RS, Lin JM, Maloney EM, Jones JF, Reeves WC. Use of medications by people with chronic fatigue syndrome and healthy persons: a population-based study of fatiguing illness in Georgia. Health Qual Life Outcomes. 2009 Jul 20;7:67.

    [2] Reeves WC, Wagner D, Nisenbaum R, Jones JF, Gurbaxani B, Solomon L, Papanicolaou DA, Unger ER, Vernon SD, Heim C. Chronic fatigue syndrome--a clinically empirical approach to its definition and study. BMC Med. 2005 Dec 15;3:19.

    [3] Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome; a comprehensive approach to its definition and study. Ann Int Med 1994, 121:953-959.

    [4] Reyes M, Nisenbaum R, Hoaglin DC, Unger ER, Emmons C, Randall B, Stewart JA, Abbey S, Jones JF, Gantz N, Minden S, Reeves WC: Prevalence and incidence of chronic fatigue syndrome in Wichita, Kansas. Arch Int Med 2003, 163:1530-1536.

    [5] Reeves WC, Jones JF, Maloney E, Heim C, Hoaglin DC, Boneva RS, Morrissey M, Devlin R. Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia. Popul Health Metr. 2007 Jun 8;5:5.

    [6] Jason LA, Richman JA. How science can stigmatize: The case of chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome 2008, 14, 85-103.

    [7] Jason LA, Najar N, Porter N, Reh C. Evaluating the Centers for Disease Control’s empirical chronic fatigue syndrome case definition. Journal of Disability Policy Studies 2009, 20, 93-100. doi:10.1177/1044207308325995

    Competing interests

    No competing interests