"Is CBT for chronic fatigue syndrome also effective for pain symptoms?" (Knoop et al., 2007)

[Dolphin]

I would be interested in people's thoughts on this paper in the coming weeks or months.

The free full text is available here:
http://repository.ubn.ru.nl/bitstream/2066/65596/1/65596_cognbethf.pdf#page=21

It is quoted as the only evidence for CBT in this recently-published paper: "Pain in patients with chronic fatigue syndrome: time for specific pain treatment?" http://forums.phoenixrising.me/inde...pecific-pain-treatment-nijs-et-al-2012.19499/

I think it'd be good to challenge this latter paper in one or more letters. Two of the authors of the latter paper are also authors of this paper (including the corresponding author of this paper) so I think one can probably spend more time criticising it than usual.

To me, it looks like an odd paper on a RCT.
Knoop, Bleijenberg and co like to hype the efficacy and safety of CBT - people may remember them from some other papers.

Is cognitive behaviour therapy for chronic fatigue syndrome also effective for pain symptoms?

Knoop H, Stulemeijer M, Prins JB, van der Meer JW, Bleijenberg G.

Behav Res Ther. 2007 Sep;45(9):2034-43. Epub 2007 Mar 14.

Source
Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Post Box 9011, 6525 EC Nijmegen, The Netherlands. j.knoop@nkcv.umcn.nl

Abstract*

Patients with chronic fatigue syndrome (CFS) frequently report chronic pain symptoms.

Cognitive behavioural therapy (CBT) for CFS results in a reduction of fatigue, but is not aimed at pain symptoms.

In this study, we tested the hypothesis that a successful treatment of CFS can also lead to a reduction of pain.

The second objective was to explore possible mechanisms of changes in pain.

The third objective was to assess the predictive value of pain for treatment outcome.

Data from two previous CBT studies were used, one of adult CFS patients (n=96) and one of adolescent CFS patients (n=32).

Pain severity was assessed with a daily self-observation list at baseline and post-treatment.

The location of pain in adults was assessed with the McGill Pain Questionnaire (MPQ).

Patients were divided into recovered and non-recovered groups.

Recovery was defined as reaching a post-treatment level of fatigue within normal range.

Recovered adult and adolescent CFS patients reported a significant reduction of pain severity compared to non-recovered patients.

Recovered adult patients also had fewer pain locations following treatment.

The decrease in fatigue predicted the change in pain severity.

In adult patients, a higher pain severity at baseline was associated with a negative treatment outcome.

PMID: 17451642 [PubMed - indexed for MEDLINE]
Publication Types, MeSH Terms

I've given each sentence its own paragraph

 

[Tito]

What about CBT to solve global warming?

 

[Simon]

Just a couple of quick observations:

• The decrease in fatigue predicted the change in pain severity.

  I'm not sure the logic that CBT has a specific effect on pain is robust. Personally I find that all my symptoms, including pain, get worse - or better - as my overall health fluctuates. So I could argue that relapses have a specific effect on pain for me, but I think it would be more accurate to say relapses make my ME much worse and pain worsens along with fatigue.

• In adult patients, a higher pain severity at baseline was associated with a negative treatment outcome... Multiple regression showed that the DOP score at baseline was a significant predictor of the change in fatigue in adult patients

  The problem here is that the effect is very small, with a correlation coefficient of -0.26 and only 6% of the variance explained (it was 36% for the decrease in fatigue predicting decrease in pain, above). The effect wasn't significant in the adolescent group, only in the adult group.

 

[PhoenixDown]

INTRODUCTION
Chronic fatigue syndrome (CFS) is characterised by severe fatigue lasting longer than 6
months and leading to functional impairment. CFS is neither the result of an organic disease
or ongoing exertion nor alleviated by rest.

Says it all really.

It's also yet another pain study that neglects to measure (even subjectively) the rate at which pain worsens in a given muscle group or joint, given an equal stimulus (hold a 1KG weight for as long as you can) before and after treatment. It neglects to measure (even subjectively) how long that muscle group or joint is permanently sensitised to pain. Several years ago with my same illness, I would barely show up as having any pain because most of it rested off, however the rate of pain increase was worsened & the envelope or limit of activity without damage was worsened permanently yet these are never measured in studies or even patient surveys. So back then if I rested and didn't do much I could say I had very mild pain, doctors or researchers would ignore the fact that my pain rapidly increases within minutes or even seconds depending on activity.

The term Fibromyalgia is terribly misplaced when applied to patients like me, because it doesn't account the worsening of the rate at which pain increases. Annoyingly I don't fit into the classical PEM phenomenon either.

It's hard to justify their lack of insight especially after I've explained it to them. It seems they are ignoring such symptoms and then calling their research "Evidence Based Medicine".

 

[SilverbladeTE]

At this point, I would like to suggest that using CBT/GET for ME treatment in any form, is like using a cheese grater to cure a Sexually Transmitted Disease!


a thought for today, from the Twilight Zone