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Pain in patients with chronic fatigue syndrome: time for specific pain treatment? (Nijs et al, 2012)

Discussion in 'Latest ME/CFS Research' started by Dolphin, Sep 22, 2012.

  1. Dolphin

    Dolphin Senior Member

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    Free full text: http://www.painphysicianjournal.com/2012/september/2012;15;E677-E686.pdf


    I've given each sentence its own paragraph
     
  2. Dolphin

    Dolphin Senior Member

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    I think it'd be good if one or more letters went in on this one. Here are the guidelines:
    http://www.painphysicianjournal.com/2009;12;1-7.pdf


    1000 words is more generous than most guidelines. I have used more than 10 references in some letters before. However, many only say five. So this gives more scope for more detailed responses than many journals.

    The impact factor is high: 10.722 (ref: http://www.painphysicianjournal.com/ ). The BMJ has an impact factor of 13.66 and the Lancet, 30.76, but the impact factor for most journals is in single figures.
     
  3. taniaaust1

    taniaaust1

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    Im very good they are looking at other symptoms rather then just fatigue but the following part did bother me

    sighs.. so we are seen as catastrophizing our pain. When will the medical profession get that rather we are often down playing the pain not catastrophizing it. Focusing on pain dont help most of us, most of us are aware that focusing on the negatives will make us iller (not just in increasing the pain), so its something most of us try to avoid doing esp when we have so many other symptoms which are concerning us.
     
  4. Dolphin

    Dolphin Senior Member

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    In the abstract it says:
    It turns out this is based on one RCT (from the Nijmegen team - the team who claim CBT regularly leads to recovery):

    Here is the CBT section:

    They later make the following claim regarding CBT (in discussion):

    Reviews generally don't get away with saying such things based on one paper, as far as I know.
     
    Simon likes this.
  5. Snow Leopard

    Snow Leopard Senior Member

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    How has recent research increased our understanding if we still have little understanding of the underlying mechanism!?!
     
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  6. Dolphin

    Dolphin Senior Member

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    Not a major point but I dislike this little section because it gives the impression there was too much specialized testing but also, I'm not sure how this leads on to
    ---------

    Later on, single studies are taken as evidence for various interventions, but single studies appear to be dismissed here if they don't suit.

    -------------
    The following findings are seen as evidence of generalized hypersensitivity even though there could be other explanations.


    -------
    Again, there could be other reasons e.g. study found an increase of acid following exercise:

     
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  7. Esther12

    Esther12 Senior Member

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    ?

    I didn't know it was nearly that high.
     
  8. Dolphin

    Dolphin Senior Member

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    Here's the study:

    Surprises me also.
     
  9. Dolphin

    Dolphin Senior Member

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    Some more comments:

    This gives impression that patients aren't prone to side effects due to exercise intolerance in phases of graded exercise
    therapy which are not early phases (basically that it would disappear after a while).
    -----

    I don't think there is evidence for either of those two statements for CFS i.e. data on adherence. The second point may follow on from ref 61 so may be ok as such, but still not proven for CFS specifically.
    They seem to want patients to adhere to exercise programs even though they don't really know for sure they're safe.

    Reference 61
     
    Simon likes this.
  10. Dolphin

    Dolphin Senior Member

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    Some more comments:

    Discussion section:

    - seems premature

    ------------


    Their approach basically is that the only biology involved is central sensitization yet all they have shown is central sensitization partly accounts for pain.

    ------------


    I'm not convinced by this "logic".
     
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  11. biophile

    biophile Places I'd rather be.

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    LOL, I love it when sweeping generalizations are based on anecdotes or single studies of poor quality or with questionable context. It gives me such confidence in the competence of the authors and the quality of peer review.
     
    Shell likes this.
  12. Esther12

    Esther12 Senior Member

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    Ta D. I think I've read more recent research which found a much lower %. I guess that a lot will depend upon the patients being looked at, criteria used, researcher's biases/preferences, etc. (I hate CFS research).

    Seeing as chronic pain is such a common problem with HMS, it seems slightly crazy for them to be so dismissive of this finding just because others with CFS suffer from pain too.
     
  13. Snow Leopard

    Snow Leopard Senior Member

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    All this talk about "central sensitisation" and you'd think that they'd actually done some research investigating how it occurs biologically.
     
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  14. Guido den Broeder

    Guido den Broeder *****

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    It seems that none of the authors has ever heard of lactic acid.
     
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  15. Hope123

    Hope123 Senior Member

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    Another activity I have no energy for but it would be good for someone to look into and write about what central sensitization is. My understanding so far is that this particular research group believes that there is no actual tissue damage from ME/CFS and that the amount of pain/ fatigue are normal bodily sensations that are amplified in our brains and that somehow, by using CBT or something like that, it will decrease the amplification and lead to recovery or substantial improvement. This is opposed to the argument put out in the ICC (and even in other fields) that pain/ fatigue are important signals that should not be ignored as they likely signify biological problems. In addition, I don't know if this groups doesn't know or simply ignores evidence like ME/CFS autopsy studies that show inflammation in the PERIPHERAL (not central) nervous system and exercise studies for instance showing abnormalities in peripheral non-neurologic systems. To me the central sensitization theory is still a lot of handwaving but I don't have the means to read through the central sensitization theory to refute it as well as I would like.

    http://www.meassociation.org.uk/?p=12558
     
  16. Tom Kindlon

    Tom Kindlon Senior Member

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    I submitted a letter to the editor at the time but it wasn't accepted.

    I've now posted it on PubMed Commons which anyone can read (although it may not be visible on some mobile devices)
    People on mobile devices may need to click "Standard PubMed" to see it (it's under the abstract).
     
    Last edited: Jan 27, 2014
    Valentijn likes this.

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