Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain an RCT, 2021, Asher, Gordon et al

Again, you seem to miss the point. We do not know enough more to make useful predictions because there are crucial steps in neural function for which we have no quantitative analysis that would allow us to explain the difference between normality and disease.

I have previously mentioned what I call the fallacy of explaining illness with normal function. One of the strange things about not only psychology but even things like immunology is that people think that we can explain disease using normal physiology. If stress caused ME/CFS then everyone stressed would have ME/CFS. They don't. What we need for an explanation of MECFS is why it does not follow what we know about pathways and responses. None of the stuff in the review you posted tells us why people have ME/CFS symptoms because it is all based on what we know about normal physiology. It gives no clue as to where the deviation is.

 

Yes, but anyone with any knowledge of methodology can see this study is meaningless.

 

Do you seriously believe that this study constitutes evidence of any kind? Have you read the critique in this thread?

 

And the reason why the methodology is no good is because it does not take into account the psychology of people doing trials!

 

People always judge others behavior in terms of how they think they would react in a certain situation. But I think that ignores what it would be like to experience the world as someone else, everyone has reasons for why they act like they do, even if in hindsight that person realizes they weren't good reasons.

For the person who hears and sees helicopters that only exist in their perception, it is so easy to write them off as crazy from our collective perspective. But if you were actually convinced that you were being hunted because you could see and hear things coming would it would be rational to run and hide in that moment? Is there any action anyone could take that is irrational from their own perspective?

 

I don’t think we can assume that all actions have a rational basis. But that doesn’t make the irrational actions wrong.

 

Yes, I read the first page of critiques, and didn't find them very convincing. Did you? Calling the authors idiots and the treatment brainwashing. Pointing out changes in alcohol consumption, even those weren't statistically significant.

 

Check one of my replies to you earlier today earlier in this thread. I never claimed pwME have an "emotional attachment to pain". I was simply explaining that pain in general has an emotional component. This isn't controversial or in doubt.

 

It seems like you missed the points about the combination of a lack of blinding and subjective outcome measures, the lack of a proper control group, how the intervention encourages a reframing of the topics of the subjective outcomes in a way that might influence the answers provided in other ways than changing the things they try to measure, etc.

 

@Trish this is where the talk about emotional attachment to pain started. This was a response to a reply that talked about ignoring pain.

Now to the current conversation:

Is this the one you mean, @dundrum ?

Jonathan’s response to the above:

@dundrum what do you mean when you say that pain has an emotional component?

 

The main point you make is that it is subjective, and yes it is, but that is the nature of pain. There are no objective measures. We have to believe the patients when they tell us they are in pain, and when they are in less pain. Yes, that is subject to bias. That doesn't mean the study is worthless. It is based on sound neuroscience, and they seemed to do everything they could to reduce bias (including having the placebo group).

Perhaps it would be helpful for you to explain how you would create a better trial.

 

Yes it does, because you cannot relay on subjective measures in an open label study. This is absolutely basic methodology. And you cannot argue that because there seems to no way to get objective measures you are allowed to say that the subjective ones are reliable. Reliability is not negotiable in that way.

It is very tough doing studies in this area but there is no point doing studies that tell us nothing. There are ways of mitigating expectation bias but they are very difficult to apply within standard ethical requirements for informed consent. But, as said above, you cannot ask other people to come up with better trials and if they don't, claim this one is OK. Reliability is not negotiable.

And it is not based on sound neuroscience. It is based on vague speculations that have borrowed neuroscience sounding terms.

 

I’m sorry, but have you really read the critique here? The quality of the placebo is extremely bad, to the point that I would be professionally embarrassed to publish such a methodologically flawed study.

 

I noted a peculiar journal quirk, that I think we have come across before, with this study. You can access the study on PubMed. You can also access the authors' reply to a critical comment. But the critical comment, probably in the form of a letter, is not listed. It may be that one can access it through the journal via one's institution, but there is an asymmetry here that isn't right.

 

You may not have seen my post earlier in the thread where I asked you if you accepted that you can't rely on subjective measures (people saying how they feel) in an open-label trial. Do you not accept that? And if you don't, why do you think that drug trials are double-blind and placebo-controlled?

[Edit: Sorry, my earlier post was on the thread on brain-training.]