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Review: cognitive behaviour therapy and behaviour therapy may be effective for back pain and chronic fatigue syndrome, and antidepressants may be effective for irritable bowel syndrome

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 QUESTION: In patients with 3 common somatic conditions (chronic fatigue syndrome, irritable bowel syndrome, and chronic back pain), what is the effectiveness of mental health interventions?

Data sources

English language studies published between 1966 and September 2001 were identified by searching PubMed, the Cochrane Library, PsycLIT, and EMBASE/Excerpta Medica. Bibliographies of relevant studies and reviews were scanned, and experts were contacted.

Study selection

Studies were selected if they were randomised controlled trials (RCTs) of patients with chronic fatigue syndrome, irritable bowel syndrome, or chronic back pain for which no physical cause could be found.

Data extraction

Data were extracted on study quality, patient characteristics, interventions, outcomes, dropouts, and reasons for withdrawal.

Main results

61 RCTs were identified; 20 were classified as primary care and 41 as secondary care. For patients with chronic back pain, cognitive behaviour therapy (7 studies in primary care [891 patients] and 9 in secondary care [625 patients]) showed …

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  • Source of funding: in part, Medical Research Council.

  • For correspondence: Dr R Raine, London School of Hygiene and Tropical Medicine, London, UK. rosalind.raine{at}