Functional improvement is accompanied by reduced pain in adolescent chronic fatigue syndrome

[Dolphin]

There's no abstract for this.

Pain Med. 2013 Sep;14(9):1435-8. doi: 10.1111/pme.12181. Epub 2013 Jun 26.

Functional improvement is accompanied by reduced pain in adolescent chronic fatigue syndrome.

Nijhof SL1, Priesterbach LP, Bleijenberg G, Engelbert RH, van de Putte EM.

Author information

1Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht.

All participants in this pain study were treated with CBT, either internet-based (55 of 72 of the participating patients) or face to face

So they've combined the two arms of the FITNET trial (although didn't use all the people in the control group)

Group analyses were performed on the basis of whether the adolescents had recovered (yes/no) from CFS at 12-month follow-up. Recovery from CFS was defined, in relation to healthy peers (2 standard deviation [SD]) in accordance with the FITNET trial as a combination of fatigue scores (CIS-20 fatigue scale <40), physical functioning (CHQ physical functioning scale 85%), school attendance within normal limits (>90%), and if the patient rates himself or herself as having recovered (SRI: “I have completely recovered” or “I feel much better”)

The pain scores (they use two measures) are certainly a lot better in the so-called "recovered" group:


Pain scores at baseline
Average pain threshold (0–11 kg)
Recovered: 5.8 (1.9)
Non-recovered: 5.7 (1.5)
p-value: 0.901
Mean Difference (95% CI) 0.1 (-0.7 to 0.9)
Adjusted Difference (95% CI)† 0.0 (-0.9 to 0.8)

Average DOP (score range 0–16)
Recovered: 5.0 (3.0)
Non-recovered: 6.5 (3.9)
p-value: 0.072
Mean Difference (95% CI) -1.5 (-3.2 to 0.1)
Adjusted Difference (95% CI)† -1.2 (-2.9 to 0.4)

Pain scores at 12-month follow-up
Average pain threshold (0–11 kg)
Recovered: 7.6 (2.3)
Non-recovered: 6.3 (2.3)
p-value: 0.019
Mean Difference (95% CI) 1.3 (0.2 to 2.4)
Adjusted Difference (95% CI)† 1.2 (0.2 to 2.2)
†
Adjusted for age, gender, anxiety, depression, average pain threshold at baseline, and average DOP at baseline

Average DOP (score range 0–16) .
Recovered: 2.0 (2.4)
Non-recovered: 5.8 (3.6)
p-value: <0.001
Mean Difference (95% CI) -3.8 (-5.2 to 2.3)
Adjusted Difference (95% CI)† -2.9 (-4.2 to 1.6)
† Adjusted for age, gender, anxiety, depression, average pain threshold at baseline, and average DOP at baseline

However, I don't think this is that amazing: if one looked at people who had no therapy and were being classed as recovered (or much improved), they likely would also have much better pain scores than a group that had rated themselves less well by other measures.

 

[Dolphin]

It is important to note that the recovered group don't have the same scores as healthy controls:

Mean pain thresholds and symptoms in the recovered group were between 1 and 2 SD of the population mean (healthy controls: average pain threshold of 9.8 [SD 1.4] [8]; mean DOP scores adults: 1.0 [SD 1.3] [18]; mean DOP scores adolescents: 0.73 (SD 0.86), unpublished data).

This would mean that the results are statistically different from healthy controls, suggesting the "recovered" still can't be considered as back to normal.

 

[Tito]

2 standard deviations is quite a substantial range... On a Gaussian curve, with 2 SD each side of the average, you actually have 95.5% of the population. Also, 90% of school attendance, that is still 1 day off sick every other week. Over 10 months, that is 22 school days. This is quite substantial. It seems as the "recovered" could certainly be mild patients, but also moderate ME patients.

 

[Esther12]

The pain scores (they use two measures) are certainly a lot better in the so-called "recovered" group. However, I don't think this is that amazing: if one looked at people who had no therapy and were being classed as recovered, they likely would also have much better pain scores.

That's what I'd have thought.

and if the patient rates himself or herself as having recovered (SRI: “I have completely recovered” or “I feel much better”)

I thought FITNET had required people to rate themselves as 'completely recovered' to be classed as recovered? [I was wrong - 39% rated themselves as fully recovered though] It sounds like patients rating themselves as feeling much better had consciously chosen not to rate themselves as recovered.

 

[lansbergen]

I am not an adolescent but an old woman. All my life I functioned better if the pain from an injury lessened.

During my improvement from very severe ME it was also: less pain better functioning. Not the other way around.

I have improved a lot but when the pain worsens I function less well.