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Perrin claims 86% success rate diagnosing ME/CFS

keenly

Senior Member
Messages
814
Location
UK
Colour me unconvinced. Beyond lots of testimonials, what scientific evidence does he have that ME/CFS can, essentially, be cured by a fancy massage? If the mechanism is some sort of failure of the lymphatic system, has there been any experiments that actually try and measure the movement of lymph fluid? Any evidence that lymph fluid is flowing 'in the wrong direction'?

This study, IMHO, provides little decent scientific evidence: the confounding factors are too large. An 'advanced practioner' might well be able to get an inkling (even if only subconciously) whether the person they are examining is unwell vs a healthy control, regardless of what prodding and poking they do. Compare ME/CFS patients with, say, MS patients as a control and I'll revisit my view on that.

Otherwise, I'll tick off the following red flags:
  • 'Osteopathic approach'
  • Trademarked process
  • 'Buy this DVD to learn more!'
  • AFAIK, not a single paper on Pubmed testing the Perrin Technique itself, just this 'diagnosis' paper and the original hypothesis paper that appears only to have been cited in English by a couple of chiropractors in alternative health journal.
  • Apparently very simple approach for a highly complex illness.

Think I'll file this one next to the SMILE trial.

Perrin does NOT claim this is a cure. FACT. I spoke to him direct about this. It helps. EVERYONE on here right now is faced with a bombardment of toxins daily. How does our body clear these? Perrins technique helps, not cure.
 

keenly

Senior Member
Messages
814
Location
UK
Interesting. I saw Raymond about 6 years ago. He was using these criteria then, and I only met one, the fifth. Nevertheless he agreed I had ME (at that point I had had 29 years of relapses and remissions, was in a bad spell when I saw him, and met the CCC definition.)

I had about 45 lymphatic drainage and cranial osteopathy treatments over a period of a year, sometimes from him and sometimes from one of his osteopaths. I was no better and no worse.

Is this more evidence that ME is a cluster of heterogeneous conditions?

(I should say that I found Raymond to be a lovely man, who is genuinely putting a lot of effort into helping people find some relief from their symptoms.)

'What happens when the systems that controls ROS and limits its damage is itself compromised?
Examples include SOD, GPx activity and GSH/GSSG ratios. The answer, I believe, is a grand move by the life-form to a lower energy state with less oxygen utilization and with less free energy G and that state is called CFS. It
is a survival state not unlike hibernation. Any strong movement to a higher metabolic rate and greater oxygen utilization without addressing this problem or better still the cause of it can be dangerous and counter-productive. Do not awaken the hibernating bear unless winter has passed'- Dr Paul Cheney.
 

ukxmrv

Senior Member
Messages
4,413
Location
London
I can't give you the earliest date for this but it was no later than 1994, which is when he began a series of small trials, the first of which incorporated Perrin's Point. The paper was published in 1998, so that ties in nicely with your doctor's interest but it's odd to confuse that with the thoracic outlet, so maybe your doctor was looking at something else entirely.

Edit: Note that the thoracic duct comes out an area adjacent to the thoracic outlet. If you look at @Hip's diagram, the tender point is where the duct turns near the clavicle.

They are looking at different points. From Hip's diagram I can see that the Perrin's point is further down the chest from where my doctor was examining me.
 

Learner1

Senior Member
Messages
6,305
Location
Pacific Northwest
No tenderness at the Perrin point.

While the lymphatic system is important to health, I'm skeptical that Perrin's technique could fix me or many of us.

I've had extensive lymphatic massage, cranial sacral therapy and strain-countersstrain techniques which worked on all aspects of lymphatic flow. I'm still sick. And no one diagnosed me with ME/CFS with any of these, an ME/CFS expert did.

No matter how wonderful the treatment is, It won't kill infections, fix nutrient deficiencies, get toxinsxdeeply embedded in mitochondria out, reverse autoantibodies, fix a broken immune system, etc.

Its one modality that may provide limited benefit.
 

Hip

Senior Member
Messages
17,824
No tenderness at the Perrin point.

When examining for Perrin's point tenderness, I think you need to search around the Perrin's point area for tender spots, because the tenderness may not be exactly at Perrin's point. Not that I have any expertise in this matter, but that's what I found myself: when I press the spot that exactly corresponds to Perrin's point, there is only mild tenderness, but just slightly further away the tenderness is much stronger.

The study discussed in this thread says that Perrin's point is located 2–3 cm left and 2–3 cm above the left nipple. That would correspond to a 45 degree diagonal distance of about 3.5 cm from the nipple to Perrin's point. See the diagram below.

Location of Perrin's point
Perrin's Point 2.jpg

So when I press at the point at a diagonal distance of 3.5 cm from the center of my left nipple, there is only mild tenderness; but if I move my finger slightly further along the diagonal to 5.5 cm from the center of the nipple, then the tenderness is much more apparent.

So I am guessing that you have to feel around the Perrin's point area for any spots of tenderness.
 

Hip

Senior Member
Messages
17,824
osteopaths, massage therapists and physiotherapists would be completely unable to make a differential diagnosis of ME/CFS using such techniques with any accuracy if the studies tried to replicate an actual real-world diagnosis in a clinic where other diseases would be present.

It is simply not possible to provide an accurate differential diagnoses of ME/CFS from other diseases such as anaemias, autoimmune diseases, cardiac disease, endocrine disorders, infectious diseases, intestinal diseases, malignancies, neurological disorders, primary psychiatric disorders, significant pulmonary disease and primary sleep disorders by prodding, poking, and feeling the rhythmic pulse of the head.

I agree with your critique that in real world situations of clinical diagnosis, you are not differentiating ME/CFS patients from healthy people, but trying to differentiate ME/CFS from various other diseases that might present with ME/CFS-like clinical signs and symptoms, such as hypothyroidism, celiac disease, anemia and systemic lupus erythematosus — diseases which are often mistaken for ME/CFS.

As @pattismith mentioned in this post, Perrin's diagnostic technique for ME/CFS has not been validated against the plethora of other diseases that doctors encounter in clinical practice. Indeed, we do not know whether these other diseases might also present with Perrin's point tenderness and the other clinical signs used by Raymond Perrin to distinguish ME/CFS.



I should point out that tenderness at Perrin's point appears to be the central clinical sign used to diagnose ME/CFS: if you look at an earlier 2011 independent study, Perrin's point tenderness alone was able to distinguish ME/CFS patients from healthy people with 81% sensitivity. This current study also used Perrin's point tenderness, and added 4 extra clinical signs to the criteria, and but was only able to marginally increase the sensitivity to 86%. So it is clear that Perrin's point tenderness is the central diagnostic clinical sign.

So far, the results of my poll are showing that Perrin's point tenderness is more often than not present in ME/CFS.
 
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Learner1

Senior Member
Messages
6,305
Location
Pacific Northwest
When examining for Perrin's point tenderness, I think you need to search around the Perrin's point area for tender spots, because the tenderness may not be exactly at Perrin's point. Not that I have any expertise in this matter, but that's what I found myself: when I press the spot that exactly corresponds to Perrin's point, there is only mild tenderness, but just slightly further away the tenderness is much stronger.

The study discussed in this thread says that Perrin's point is located 2–3 cm left and 2–3 cm above the left nipple. That would correspond to a 45 degree diagonal distance of about 3.5 cm from the nipple to Perrin's point. See the diagram below.

Location of Perrin's point
View attachment 25107

So when I press at the point at a diagonal distance of 3.5 cm from the center of my left nipple, there is only mild tenderness; but if I move my finger slightly further along the diagonal to 5.5 cm from the center of the nipple, then the tenderness is much more apparent.

So I am guessing that you have to feel around the Perrin's point area for any spots of tenderness.
Thanks! Still no luck.... Maybe it works better on men. Or maybe its because I already have done these lymphatic modalities...

Like I said, I'm a firm believer in the importance of the lymphatic system, but its ridiculous to think that clearing lymph out, which I'm pretty experienced at already, is going to fix most of us. It may be a component of a comprehensive solutuon, but its not a solution in itself...
 

Hip

Senior Member
Messages
17,824
Like I said, I'm a firm believer in the importance of the lymphatic system, but its ridiculous to think that clearing lymph out, which I'm pretty experienced at already, is going to fix most of us. It may be a component of a comprehensive solutuon, but its not a solution in itself...

I tend to agree, and there is no information I could find about the success rate of Perrin's techniques for treating ME/CFS.

Although I think we need to separate his treatment techniques from the diagnostic techniques. The studies discussed in this thread are more about the diagnostic value of Perrin's point tenderness.
 

Londinium

Senior Member
Messages
178
Perrin does NOT claim this is a cure. FACT. I spoke to him direct about this. It helps. EVERYONE on here right now is faced with a bombardment of toxins daily. How does our body clear these? Perrins technique helps, not cure.

'Toxins' is one of those words that get thrown about by practioners of stuff like this which sound sciencey but in the context in which they're used are incredily unspecific. See also: 'energy'; 'natural'.

Without specifying what one means by the term, it impossible to deny that 'everyone on here right now is faced by a bombardment of toxins daily'. But so is everyboody else on the planet. 'Toxins' is such a catch-all term as to be meaningless. If it were just exposure to 'toxins' that was the issue then everybody would be sick, rather than the 0.2-0.4% of the population that have ME/CFS.

'Ah hah!' says the practioner. 'But people with ME/CFS have insufficient [insert sciencey term like 'lymphatic drainage' or similar]!'

Which is fair enough if, y'know, said practioner can provide any evidence that the lymphatic system is actually impaired. Some evidence to support the underlying hypothesised mechanism would be nice. There would be plenty of ways to test this beyond the groundbreaking evidence that, er, sick people look different to healthy people and that it's quite uncomfortable to have a finger jabbed into one's boob.

'But some people felt better after my therapeutic manipulation!' comes the reply. Well, um, yes. But cancer patients feel better after a hand massage, without it meaning that carcinomas are actually due to poor knuckle joint flexibility...
 

rodgergrummidge

Senior Member
Messages
124
I should point out that tenderness at Perrin's point appears to be the central clinical sign used to diagnose ME/CFS: if you look at an earlier 2011 independent study, Perrin's point tenderness alone was able to distinguish ME/CFS patients from healthy people with 81% sensitivity. This current study also used Perrin's point tenderness, and added 4 extra clinical signs to the criteria, and but was only able to marginally increase the sensitivity to 86%. So it is clear that Perrin's point tenderness is the central diagnostic clinical sign.

@Hip , the 2011 study you quote above doesnt provide any credible evidence for the use 'tenderness' spots in diagnosing CFS. The science is so appalling that I thought it might be useful to discuss further, given that there are so many comments and interest in Perrin Spots.

I have pasted the one (1) page from the 2011 paper that contains the entire Results Section below. Note the:
  • entire results are described in 1 paragraph (yellow highlight)
  • complete lack of scientific method used by the authors for measuring 'tenderness' (see Methods "Examination", yellow highlight)
  • the method of "Any undue unilateral tenderness was noted and compared to the contralateral side." is completely meaningless in terms of data collection and so the statistical analysis is also meaningless
  • authors do not even describe precisely which part of the thorax was examined (Methods, "Examination)
  • authors do not indicate whether the patients were randomized or whether the investigators were 'blinded'
I appreciate that diagnosing CFS is difficult, but such papers dont offer an alternative that is backed by any scientific evidence. If an osteopath using the Perrin Technique can make a more accurate diagnosis of ME/CFS than a doctor, it would be a very simple matter of performing a well-designed study and backing the claims with solid evidence.

Rodger
upload_2017-11-17_10-17-17.png
 

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Hip

Senior Member
Messages
17,824
the method of "Any undue unilateral tenderness was noted and compared to the contralateral side." is completely meaningless in terms of data collection and so the statistical analysis is also meaningless

As a medical term, tenderness means when pain or discomfort occurs on touching or pressing an area, but with pain or discomfort not being present when the area is not touched. Ref: here.

Pain from pressing an area is often used as a clinical symptom in disease diagnosis, so I don't really see why you are saying it is meaningless.


authors do not even describe precisely which part of the thorax was examined (Methods, "Examination)

Presumably they examined all the thorax, but it was only in the third intercostal space on the left that tenderness was noted.


authors do not indicate whether the patients were randomized or whether the investigators were 'blinded'

I don't think it was blinded, as in the abstract it says:
Further studies, preferably blinded and combined with appropriate imaging, are required.

So that suggests the study was not blinded, but that the authors are aware that future replication studies should be blinded.

I certainly agree that blinding would be necessary in order for Perrin's point tenderness to be properly tested as a clinical sign for ME/CFS.

What I would like to see is a study in which not only do the investigators not know who are the patients and who are the healthy controls, but I'd like to see the entire face and body of the patients and healthy controls hidden behind a screen or cotton sheet, with only their torso visible for physical examination. This is so that the investigator does not pick up any other clues from the person's general body language and facial expression, which might give away whether they are an energy-sapped patient or a more vibrant healthy control.
 
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keenly

Senior Member
Messages
814
Location
UK
'Toxins' is one of those words that get thrown about by practioners of stuff like this which sound sciencey but in the context in which they're used are incredily unspecific. See also: 'energy'; 'natural'.

Without specifying what one means by the term, it impossible to deny that 'everyone on here right now is faced by a bombardment of toxins daily'. But so is everyboody else on the planet. 'Toxins' is such a catch-all term as to be meaningless. If it were just exposure to 'toxins' that was the issue then everybody would be sick, rather than the 0.2-0.4% of the population that have ME/CFS.

'Ah hah!' says the practioner. 'But people with ME/CFS have insufficient [insert sciencey term like 'lymphatic drainage' or similar]!'

Which is fair enough if, y'know, said practioner can provide any evidence that the lymphatic system is actually impaired. Some evidence to support the underlying hypothesised mechanism would be nice. There would be plenty of ways to test this beyond the groundbreaking evidence that, er, sick people look different to healthy people and that it's quite uncomfortable to have a finger jabbed into one's boob.

'But some people felt better after my therapeutic manipulation!' comes the reply. Well, um, yes. But cancer patients feel better after a hand massage, without it meaning that carcinomas are actually due to poor knuckle joint flexibility...

Most people are sick. Look around you. ME/CFS is a protective mechanism.