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

Discussion in 'Latest ME/CFS Research' started by Dolphin, Sep 23, 2012.

  1. Dolphin

    Dolphin Senior Member

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    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.

    I've given each sentence its own paragraph
    Simon likes this.
  2. Tito

    Tito Senior Member

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    What about CBT to solve global warming?
  3. Simon

    Simon

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    Monmouth, UK
    Just a couple of quick observations:
    • 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.
    • 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.
  4. PhoenixDown

    PhoenixDown Senior Member

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    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".
  5. SilverbladeTE

    SilverbladeTE Senior Member

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    Somewhere near Glasgow, Scotland
    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!
    :alien:

    a thought for today, from the Twilight Zone :p

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