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Research brief: CBT & GET have little effect on pain in PACE Trial

Discussion in 'Phoenix Rising Articles' started by Mark, Sep 5, 2013.

  1. Phoenix Rising Team

    Phoenix Rising Team

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    View the Post on the Blog


    View the Post on the Blog
     
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  2. Dolphin

    Dolphin Senior Member

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    Thanks Simon.

    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:
    -8% (APT),
    -4% (CBT),
    0% (GET)
    and
    -7% (SMC).

    Or in percentage terms of those with the symptom at baseline:
    26.3% reduction (APT),
    10.7% reduction (CBT),
    1% reduction (GET)
    and
    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:
    APT: 8,
    CBT: 16
    GET: 16
    SMC only: 11
    i.e. the biggest numbers are for CBT and GEt. One wonders what their data might be like.
     
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  3. Firestormm

    Firestormm Guest

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    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! :confused: :lol: :thumbsup:
     
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  4. Simon

    Simon

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    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!
     
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  5. taniaaust1

    taniaaust1

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    This is such a great idea to do research briefs on the PACE trial!

    Thanks Simon
     
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  6. Sean

    Sean Senior Member

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    That's gotta hurt.

    :p
     
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  7. Legendrew

    Legendrew Content team

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    Nice article - particularly like the graph. Makes it easy to understand the small effect these ''treatments'' have.
     
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  8. Dolphin

    Dolphin Senior Member

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    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.
     
  9. user9876

    user9876 Senior Member

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    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.

     
  10. Simon

    Simon

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    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.
     
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  11. Dolphin

    Dolphin Senior Member

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    From my post to the thread http://forums.phoenixrising.me/inde...eatments-in-the-pace-trial.24886/#post-382774 :


     
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  12. Dolphin

    Dolphin Senior Member

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  13. Firestormm

    Firestormm Guest

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  14. anciendaze

    anciendaze Senior Member

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    While I have elsewhere cast doubt on the distributions involved, I want to comment that, even if you assume PACE really did deal with Gaussian distributions, using Cohen's d instead of Pearson's measures would reduce the primary reported effects in the original study to something scarcely worth mentioning.

    This is in line with the extremely modest results on the only objective scale, which would not be considered clinically significant if we were talking about a serious condition like heart failure where improvements are notably difficult. (I notice that even the alleged "control" group gained 20 meters in the six-minute walk, which I therefore subtract from the gains claimed for therapy. This still leaves a bias in the form of the hidden assumption that none of those who declined a second test (around 30% in each group) would have scored lower. This is where the strategy of making objective measures secondary paid off for the PACE authors. They could use subjective measures without objective backing while claiming their study included objective measures. Had those objective measures been primary, failure to participate in both before and after tests would have removed many subjects from the trial data.)

    If my criticisms about the distribution in use are valid, the standard deviation, which plays a critical role in all such measures, could be mainly the result of arbitrary bounds and sample size.
     
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