Do treatments for paediatric chronic fatigue syndrome improve pain? a systematic review, Ascough et al, 2020 G535(P)

[John Mac]

Abstract
Aims
Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is common (prevalence 1–2%).
Two thirds of children experience moderate or severe pain, and this is associated with increased fatigue and poorer physical function. However, current treatment approaches do not target pain.
This systematic review aims to identify whether specialist treatment of paediatric CFS/ME improves pain.

Methods
We conducted a detailed search in MEDLINE, EMBASE, PsycINFO, and the Cochrane Library. Two researchers independently screened texts published since 1994 with no language restrictions.
We searched trial registration websites for unpublished trials and hand searched reference lists of all included studies.
Inclusion criteria were (1) RCTs & observational studies; (2) Participants aged <19 years with CFS/ME; 3) Measure of pain (quantitative, qualitative, or mixed methods) before and after an intervention.

Results
Of 1898 papers screened, 27 studies investigated treatments in paediatric CFS/ME, 20 of which did not measure pain. Only 5 treatment studies measured pain at baseline and follow-up and were included in this review. Four of the studies investigated behavioural interventions and one study investigated a pharmacological intervention (low dose clonidine). None of the interventions were specifically targeted at treating pain.

Pain measures used were heterogenous and included a Visual Analogue Scale, CHQ-87 Bodily Pain Subscale, Brief Pain Inventory and a mean Daily Observed Pain score. Of the included studies 2 showed no improvement in pain scores with treatment, 1 small study described an improvement in pain in one subgroup, and 2 studies identified improvements in pain measures in ‘recovered’ patients compared to ‘non-recovered patients’.

Conclusion
Despite the prevalence and impact of pain in children with CFS/ME surprisingly few treatment studies measured pain. In those studies that did measure pain, there is limited evidence that treatment helps improve pain scores. However, patients who recover appear to have less pain than those who do not recover. More studies are needed to determine if pain in paediatric CFS/ME requires a specific treatment approach, with particular focus on patients who do not recover following initial treatment.

https://adc.bmj.com/content/105/Suppl_1/A189.2

 

[MEMarge]

Another Crawley et al.
Do wish they'd stop going on about "treatment".

In fact I wish they'd stop all they are doing in ME/CFS.

 

[Peter T]

This seems predicated on a belief that there is a treatment. At present there are no meaningful treatments.

 

[rvallee]

Why ask such an irrelevant question? It's really weird how these people both pretend to be experts but work as if they are completely naïve of everything, asking questions they know to be irrelevant, in large part because their own incompetence means pain is not even a recognized problem in ME? Unless somehow I guess pain is now a sub-symptom of "fatigue", or whatever. Who cares? Let's just make all the stuff up!

Seems only to be about padding the resume of citations, since nobody ever checks the substance of such reviews.

I mean seriously:

More studies are needed to determine if pain in paediatric CFS/ME requires a specific treatment approach, with particular focus on patients who do not recover following initial treatment.

What the fuck

None of the interventions were specifically targeted at treating pain.

is wrong with them? What "initial treatment" are they even talking about here?! Seriously: WHAT INITIAL TREATMENT?!!!

In those studies that did measure pain, there is limited evidence that treatment helps improve pain scores.

I repeat: WHAT INITIAL TREATMENT?! What even is the point of peer reviewers if they don't even check the substance of the words used?

 

[Arnie Pye]

I can remember as a child that my father refused to believe that children could actually be in pain. I had a doctor who appeared to believe that too.

Edit : I should expand on that... My father didn't believe in pain in children if it was from an invisible source.

I also remember neither of my parents believed that children could be depressed. I think that was a common belief in the medical profession too.

 

[ME/CFS Skeptic]

It seems like this is merely an abstract, the full-text of the review itself is available here: https://bmjpaedsopen.bmj.com/content/4/1/e000617

 

[Denise]

ARGH! How awful!
When can we send all this sort of stuff to a toxic waste dump?

 

[Sean]

However, patients who recover appear to have less pain than those who do not recover.

On what planet does the definition of recovered include still having pain?

 

[cfsandmore]

Behold the purpose, more $tudies are needed.

I wonder how much research funding Professor Crawley brings in.

 

[Amw66]

Each paper simply reinforces how little such pediatricians actually know.

For any to be termed " expert" is denigration of the term