Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME) is associated with affected individuals being more sedentary and having a reduced breadth of activities with attendant significantly increased cardiovascular and metabolic risk [1].

The recent report by the all-party parliamentary group on ME presents an ambitious vision for ME/CFS which is to be welcomed [2]. It calls for the creation of centres for ME/CFS research excellence and updating medical training on ME/CFS, something which is to be applauded. However, we noted the critical tone in which the biopsychosocial model [3] was discussed.

The report states that ‘The biopsychosocial model of the illness has prevented many people with ME from obtaining welfare and health insurance-based benefits.’ Furthermore, it went on to state that ‘despite the scientific evidence showing that ME is a biomedical condition, there is still an inaccurate understanding of ME being perpetuated by small groups within the medical and psychological professions.’

The biopsychosocial model is not a dichotomous model where a medical condition is viewed as ‘all in the mind’ or purely medical. On the contrary, the biopsychosocial model postulates that mind and body are linked, with a complex relationship between the two [4]. The fact that there may be a psychological component does not make the condition any less valid and certainly does not preclude the fact that there may be something medically wrong. For instance, Chu (2020) [5] found that post-transplant depression was associated with significantly worse clinical outcomes in lung transplant recipients, illustrating the important mind-body link. The biopsychosocial model applies just as much to ME/CFS as to the patients whose experiences are reported in this study.

In the recently updated National Institute for Health and Care Excellence guidelines for ME/CFS, the treatment options available (based on the best available evidence) are careful energy management and supportive cognitive behavioural therapy (CBT) [6], the latter relating directly to increased activity levels with attendant health benefit. In tertiary NHS referral centres for ME/CFS assessment/treatment, a multidisciplinary team will focus on understanding the specific needs/challenges faced by the individual and will utilise the best evidence available to co-create a management plan with the patient. This approach is guided by the research and as such, would incorporate what may be revealed as evidence for the biological processes that underpin ME/CFS.

We do not believe that the answer to improving the lives of those living with ME/CFS is in discouraging the use of the biopsychosocial model. Surely, individuals living with ME/CFS are best served by a holistic biopsychosocial formulation considering all aspects of the reality of living with this very disabling condition. ME/CFS is a complex condition that requires a multi-track not uni-track treatment approach in all aspects of its management. Any intervention that can result in greater activity levels is likely to reduce cardiovascular risk.

Acknowledgements

All authors contributed equally and substantially to the co-creation and writing of this article.

Conflicts of interest

There are no conflicts of interest.

References 1. Lavie CJ, Ozemek C, Carbone S, Katzmarzyk PT, Blair SN. Sedentary behavior, exercise, and cardiovascular health. Circ Res 2019; 124:799–815. 2. All-party parliamentary group on Myalgic Encephalomyelitis (ME) Rethinking ME. A report by the All-Party Parliamentary Group on Myalgic Encephalomyelitis. Houses of Parliament; 2022. 3. Engel G. The need for a new medical model: a challenge for biomedical science. Science 1977; 196:126–129. 4. Harvey S, Wessely S. Chronic fatigue syndrome: identifying zebras amongst the horses. BMC Med 2009: 58:1–4. 5. Chu MC, Smith PJ, Reynolds JM, Palmer SM, Snyder LD, Gray AL, Blumenthal JA. Depression, immunosuppressant levels, and clinical outcomes in postlung transplant recipients. Int J Psychiatry Med 2020; 55:421–436. 6. National Institute for Health and Care Excellence (NICE). Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management. NICE Guideline nr 206. 2021. https://www.nice.org.uk/guidance/ng206.