Discussion in 'Phoenix Rising Articles' started by Mark, Sep 5, 2013.
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This a comment from the thread on the paper: I thought I'd give it more exposure. If anyone can make the table easier to read, feel free to do so in a post underneath (and I'll try to link to it):
Anyone else think it's a little suspicious that they only concentrated on muscle pain and joint pain given the table below. This is all the data we got for the other three pain symptoms.
Looking at tender lymph nodes, for example, the raw changes in percentages were:
Or in percentage terms of those with the symptom at baseline:
26.3% reduction (APT),
10.7% reduction (CBT),
1% reduction (GET)
22.1% reduction (SMC only).
The results for sore throat, although not as clear cut, also don't suggest much difference or evidence for CBT and GET (headache is intermediary)
All they say is:
(note: protocol doesn't mention they are going to do this, so there is a chance they may have had a feel for how things were going, or know from other situations)
Table 2. Presence of individual symptoms, valid % (n)
APT APT CBT CBT GET GET SMC only SMC only
Baseline 52 weeks Baseline 52 weeks Baseline 52 weeks Baseline 52 weeks
Symptom n=159 n=151 n=161 n=145 n=160 n=144 n=160 n=149
Muscle pain 71 (113) 60 (91) 64 (102) 50 (73) 71 (114) 50 (72) 72 (115) 60 (89)
Joint pain 52 (84) 49 (74) 50 (81) 34 (49) 51 (81) 39 (56) 52 (83) 45 (67)
Headache 37 (59) 31 (47) 39 (63) 28 (40) 37 (59) 29 (42) 36 (58) 34 (50)
Sore throat 32 (51) 31 (50) 33 (53) 28 (41) 29 (46) 31 (44) 30 (48) 27 (40)
Tender lymph nodes 31 (50) 23 (35) 32 (51) 28 (41) 29 (46) 29 (41) 32 (51) 25 (37)
Another point for what it's worth: the numbers whose data we don't have are:
SMC only: 11
i.e. the biggest numbers are for CBT and GEt. One wonders what their data might be like.
These 'Research briefs' are a great idea and this was a good one to start with - though I still don't get the 'cohen' chart concept - despite SImon's help!
I think that choosing the two most frequent symptoms, plus fibromyalgia as a comorbid disease is a justifiable selection - though it's a good point that the results for other pain symptoms aren't as good. Just looking at the results for other symptoms, my take on it is:
Headache: CBT best (CBT 39% -> 28% = -11%; GET -8%; APT -6%; SMC -2%)
Sore throat: looks like nothing made a difference
Tender lymph nodes: APT best (-8%, all others probably not significant)
I don't know how much difference that makes to the overall study findings which found CBT/GET made small or insignificant difference to the two most common pain symptoms. Including all symptoms would have made the results a bit weaker, but they are already pretty unimpressive!
This is such a great idea to do research briefs on the PACE trial!
That's gotta hurt.
Nice article - particularly like the graph. Makes it easy to understand the small effect these ''treatments'' have.
It wasn't that long a paper so I think they should just have given the same data for all the pain symptoms esp. given it is known there are different sorts of pain (and drugs that target different types of pain) and the title, "Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial."
It would, of course, made the discussion section (conclusions, etc.), and how people will interpret the findings, less clear cut, although as you have pointed out, even for those three, the results aren't clear cut themselves.
Its worth pointing out that they didn't follow the proper fibromyalgia diagnostic criteria as they left out the tender points. I had always thought that was a major part of the diagnosis.
I thought that too, but it seems that the 2010 criteria don't require a tender point examination:
The American College of Rheumat... Wolfe 2010] - PubMed - NCBI
So I don't really understand the authors point about 'with the exception of tender points when the paper they cite does not require tender points'. I'm afraid at that point, I thought 'whatever' and left it at that.
From my post to the thread http://forums.phoenixrising.me/inde...eatments-in-the-pace-trial.24886/#post-382774 :
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