Interventions to treat pain in paediatric CFS/ME: a systematic review - Crawley et al Jan 2020

Sly Saint

Sly Saint

Senior Member (Voting Rights)
Abstract
Background Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is common (prevalence 1%–2%). Two-thirds of children experience moderate or severe pain, which is associated with increased fatigue and poorer physical function. However, we do not know if treatment for CFS/ME improves pain.

Objective 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 between 1994 and 24 January 2019 with no language restrictions. Inclusion criteria were (1) randomised controlled trials and observational studies; (2) participants aged <19 years with CFS/ME; and (3) measure of pain before and after an intervention.

Results Of 1898 papers screened, 26 studies investigated treatment for paediatric CFS/ME, 19 of which did not measure pain at any time point. Only five treatment studies measured pain at baseline and follow-up and were included in this review. None of the interventions were specifically targeted at treating pain. Of the included studies, two showed no improvement in pain scores, one suggested an improvement in one subgroup and two studies identified improvements in pain measures in ‘recovered’ patients compared with ‘non-recovered’ patients.

Conclusions Despite the prevalence and impact of pain in children with CFS/ME surprisingly few treatment studies measured pain. In those that did measure pain, the treatments used focused on overall management of CFS/ME and we identified no treatments that were targeted specifically at managing 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 a particular focus on patients who do not recover following initial treatment.
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https://bmjpaedsopen.bmj.com/content/4/1/e000617

full paper pdf:
https://bmjpaedsopen.bmj.com/content/bmjpo/4/1/e000617.full.pdf

"However, patients who recover appear to have less pain than those who do not recover."
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I get the impression from reading the peer review comments that it is limited to a quick skim on style and not much more. It's more friendly and deferential than anything.

Jo Nijs appears to be a like-minded peer of Crawley: https://www.semanticscholar.org/author/Jo-Nijs/84058062.

So does David Vickers: https://www.ncbi.nlm.nih.gov/books/NBK53585/.

Mutual self-admiration society. Why bother with actual peer review when you can just pretend that it is? Just have your friends and colleagues "review" your work, they already have their gold star stamp wet and ready to go. Let's dispense with all the extra work needed to validate things and agree with one another.

This is completely broken. Probably one more thing to ultimately get lost in the void but whatever I think it explains a lot of what's happening, @dave30th.
 
Looks like they rate the SMILE trial as just having a moderate risk of bias.

They say "One was deemed low risk of bias and one was deemed moderate risk of bias. The remaining two were at high risk of bias following assessment."

I've forgotten the details of the RoB discussion now, but thought this could be of interest to others (@Michiel Tack)

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I vaguely remember thinking that RoB 2 meant that a trial was rated at a high risk of bias even if just one aspect of it was rated as having a high risk of bias?

Sounds like the FITNET data was rated as having a high-risk of bias: "The ROBINS-I tool suggested the longitudinal cohort study following an RCT was at high risk of bias."
 
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