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Associations Between Cognitive Performance and Pain in CFS:Comorbidity with Fibromyalgia Does Matter

Dolphin

Senior Member
Messages
17,567
Free full text: http://www.painphysicianjournal.com/current/pdf?article=MjQxOA==

Associations Between Cognitive Performance and Pain in Chronic Fatigue Syndrome: Comorbidity with Fibromyalgia Does Matter.

Pain Physician. 2015 Sep-Oct;18(5):E841-E852.

Ickmans K, Meeus M, De Kooning M, Lambrecht L, Pattyn N, Nijs J.

Abstract

BACKGROUND:

In addition to the frequently reported pain comp laints, performance-based cognitive capabilities in patients with chronic fatigue syndrome (CFS) with and without comorbid fibromyalgia (FM) are significantly worse than those of healthy controls.

In various chronic pain populations, cognitive impairments are known to be related to pain severity.

However, to the best of our knowledge, the association between cognitive performance and experimental pain measurements has never been examined in CFS patients.


OBJECTIVES:

This study aimed to examine the association between cognitive performance and self-reported as well as experimental pain measurements in CFS patients with and without FM.


STUDY DESIGN:

Observational study.


SETTING:

The present study took place at the Vrije Universiteit Brussel and the University of Antwerp.


METHODS:

Forty-eight (18 CFS-only and 30 CFS+FM) patients and 30 healthy controls were studied.

Participants first completed 3 performance-based cognitive tests designed to assess selective and sustained attention, cognitive inhibition, and working memory capacity.

Seven days later, experimental pain measurements (pressure pain thresholds [PPT], temporal summation [TS], and conditioned pain modulation [CPM]) took place and participants were asked to fill out 3 questionnaires to assess self-reported pain, fatigue, and depressive symptoms.

RESULTS:

In the CFS+FM group, the capacity of pain inhibition was significantly associated with cognitive inhibition.

Self-reported pain was significantly associated with simple reaction time in CFS-only patients.

The CFS+FM but not the CFS-only group showed a significantly lower PPT and enhanced TS compared with controls.


LIMITATIONS:

The cross-sectional nature of this study does not allow for inferences of causation.


CONCLUSIONS:

The results underline disease heterogeneity in CFS by indicating that a measure of endogenous pain inhibition might be a significant predictor of cognitive functioning in CFS patients with FM, while self-reported pain appears more appropriate to predict cognitive functioning in CFS patients without FM.

PMID:26431138 [PubMed - as supplied by publisher]
 

Dolphin

Senior Member
Messages
17,567
For the results on cognitive performance, we refer the reader to our second report (13).

13. Ickmans K, Meeus M, De Kooning M, Lambrecht L, Pattyn N, Nijs J. Can recovery of peripheral muscle function predict
cognitive task performance in chronic fatigue syndrome with and without fibromyalgia? Phys Ther 2014; 94:511-522.
So it's a lot of the same data as another study.
 

Effi

Senior Member
Messages
1,496
Location
Europe
I read the study. Some thoughts:

* CDC criteria for CFS; ACR criteria for FM
* three groups: CFS; CFS+FM; healthy controls (i.e.: inactive, but pain-free and without chronic illness).
* questionaires were SF-36; CIS (checklist individual strength); BDI-PC (Beck Depression Inventory for Primary Care).
* small sample size
* study was funded by ME Research UK

They make it sound as if virtually EVERY CFS patient has widespread and persistent pain, and only part of PWCFS have cognitive impairment. (I'd say it's the other way around!) They also clump CFS and FM together with chronic pain syndrome. As usual. This fits better into their hypothesis of central sensitisation (and the pain focus of their organization 'Pain in Motion').

One interesting conclusion they make is that in future research it would be a good idea NOT to clump together CFS and FM as if they were the same. (Wow what a find!)

In CFS+FM there was a correlation between pain and cognitive impairment. Probably because pain is a prominent feature of FM? When symptoms flare up, they usually all flare up. So I'm guessing when FM patients have a flare up of pain, they'll also have more fibro-fog.

For CFS only patients they didn't find a clear correlation between pain and cognitive function. Probably because pain is not a main symptom in CFS?

study said:
Hence, therapy should not merely target the patients’ return to physical but also to cognitive tasks.
This makes me scared: apart from GET are they going to invent something called GCT, Graduated Cognitive Training? A group therapy where you gradually solve more sudoku puzzles so your cognitive functioning improves? :bang-head::rolleyes:

study said:
The findings of this study should be interpreted minding its methodological strengths and weaknesses. First, it should be mentioned that the groups were rather small for the regression analyses. Since the power of the non-significant associations was oftentimes rather low, this could possibly explain the absence of significance in some of these associations.
Second, the cross-sectional nature of this study does not allow for inferences of causation. Additionally, given the absence of previous data regarding the association between cognitive performance and pain measurements in these subgroups, an exploratory approach was used to test several hypotheses. Although we accounted adequately for possible type I errors in the statistical analyses, the latter entails that findings must be considered cautiously.

study said:
Additionally, healthy controls had to be inactive because it is known that CFS patients, in general, have a more sedentary lifestyle
Sedentary lifestyle, housebound, bedridden, tomayto, tomahto...

study said:
Another important strength of this study is that we anticipated sources of bias like pregnancy; use of medication, caffeine, alcohol, and nicotine; and execution of physical exertion on the days of the assessments.
Patients had to get to the place where the study was held, which already accounts for excessive physical exertion for many/most CFS patients.

study said:
A final study strength worth mentioning is that we attempted to blind the assessor regarding participants’ disease status. However, this was only successful in 37.5% of the patients and in 10% of the controls.

study said:
Although larger confirmatory studies are needed, these study findings suggest that better endogenous pain inhibition could predict better mental health in patients with CFS and comorbid FM, while less selfreported pain could predict better mental health in CFS patients without FM.
Throughout the study they talk about cognitive impairment, yet in the conclusion this becomes mental health... What to make of it?

A generally underwhelming study. As per usual.

@Dolphin The fact that they made two papers out of one study which already had too small a sample size to begin with makes me wonder. In the latest months these same people have been publishing studies like there's no tomorrow. I think this has to do with the fact that there is another governmental report coming up where they're going to compare the biomedical approach (and its respective published studies) to the BPS approach (and its respective published studies). This reminds me of high school, when we'd make essays longer in page count in an attempt to hide the fact that we had nothing to say about the subject. :rolleyes:
 

Snowdrop

Rebel without a biscuit
Messages
2,933
One interesting conclusion they make is that in future research it would be a good idea NOT to clump together CFS and FM as if they were the same. (Wow what a find!)
<sigh>

This makes me scared: apart from GET are they going to invent something called GCT, Graduated Cognitive Training? A group therapy where you gradually solve more sudoku puzzles so your cognitive functioning improves? :bang-head::rolleyes:
more eyeball rolls. One thing I did was endless sudoku puzzles when I could. My stamina continues to worsen and this is more difficult.

Do any of these people ever even try talking to someone with ME or FM. Oh wait patients don't know anything about their own experience.
 

Effi

Senior Member
Messages
1,496
Location
Europe
Nij's stuff always seems quite poor and pointless without being utterly maddening, manipulative and vile. It's a bit sad that ME Research think he's the best person to fund.
He seems to be very good at talking people into things that fit his agenda but not necessarily anyone else's. I don't trust him one bit.