Pain Management through Neurocognitive Therapeutic Exercises in Hypermobile Ehlers–Danlos Syndrome Patients with Chronic Low Back Pain, 2021, Celletti

[Andy]

Abstract

Background. The hypermobile type of Ehlers–Danlos syndrome (hEDS) is likely the most common hereditary disorder of connective tissue mainly characterized by joint hypermobility. Patients with hEDS suffer joint pain, in particular low back pain, commonly resistant to drug therapy. The aim of this research was to evaluate a neurocognitive rehabilitation approach based not only on the motion and function recovery but also on the pain management.

Methods. In this nonrandomized clinical trial, eighteen hEDS patients (4 males and 14 females) with mean age 21 years (range 13-55) were recruited and evaluated before and after three months of rehabilitation treatment.

Results. The outcome scores showed significant statistical results after treatment in reducing pain symptoms (numerical rating scale, ; McGill (total score), ), fatigue (fatigue severity scale, ), fear of movement (Tampa scale, ), and pain-associated disability (Oswestry disability index, ).

Conclusion. The clinical results observed in our study seem to confirm the role of a specific neurocognitive rehabilitation program in the chronic pain management in the Ehlers–Danlos syndrome; the rehabilitation treatment should be tailored on patient problems and focused not only in the recovery of movement but also on pain perception.

Open access, https://www.hindawi.com/journals/bmri/2021/6664864/

 

[Hutan]

It's too easy to spot the problems with this one:
No controls, open label, subjective outcomes, and the treatment approach was 'throw various things at the problem including drugs', making it easy to claim that the woo treatment created any reported benefits.

All patients were consecutively enrolled in the outpatient rehabilitation unit for hypermobility disorders

The rehabilitative treatment was performed for one time a week (sixty minutes for each session) for three consecutive months. All the patients continued the daily common activities and ongoing drug therapy. The scope of the treatment has been to reduce and treat the main aspect characterizing the patients: the reduced muscle recruitment, the chronic fatigue, the fear of movement, and the recovery of an adequate motor strategy, in particular of the back spine, but always focused on the patients’ feeling of perception of pain and the functional limitations with respect to the principles of the narrative medicine

This is part of the treatment:

“Felt sense” approach or feeling felt: it is necessary to direct the bodily sensations initially focusing the attention on the healthy parts of the body and then describing the painful typology, localization, and perception in order to confine it on the low back pain region. This first 10- to 15-minute phase was based on the language and narration of lower back pain and its characteristics. For example, the patient was asked to sense the pleasant contact (comfortable warmth) of the therapist’s (PT) hands as slight pressure with the palm to the region of the back without pain. Afterward, the PT asked the patient to bind the pleasant and pain-free sensation to the painful area.

 

[Hutan]

To be fair, the authors did identify some of the problems with their study:

this study has some limitations such as the lack of a control group, a limited sample size, the evaluation done with only clinical scales, and the absence of a functional evaluation of patients like spine segmental mobility function. Then, our results, although encouraging, should be interpreted with caution.

But, those limitations did not stop them deciding that the study 'seems to confirm' a role for the hands-on back whisperers in the abstract.

The clinical results observed in our study seem to confirm the role of a specific neurocognitive rehabilitation program in the chronic pain management in the Ehlers–Danlos syndrome; the rehabilitation treatment should be tailored on patient problems and focused not only in the recovery of movement but also on pain perception.

 

[rvallee]

At least snake oil medicine had cocaine and heroine and other active ingredients. This is significant regression compared to snake oil medicine.

It's pretty clear that people using this kind of methodology are attracted by how easy it is to just say and do whatever you want and conclude anything you wish out of it, it's just a mindless serial questionnaire process that requires no effort. It's being paid to do real work without doing any actual work, basically like a class where are encouraged to use cheat sheets, the very people who will use it are the last who should.

 

[Invisible Woman]

For example, the patient was asked to sense the pleasant contact (comfortable warmth) of the therapist’s (PT) hands as slight pressure with the palm to the region of the back without pain. Afterward, the PT asked the patient to bind the pleasant and pain-free sensation to the painful area.

See, I'm a bit bemused here.

Touch, especially the touch of someone you trust, can be extremely comforting.

When I was in a lot of pain thanks to a gynae issue my husband placing his warm hand on my lower back (heavy, dull ache) was very soothing. Mind you if he'd touched my abdomen (viciously, sharp pain) I'd probably have visited violence upon his person - not that I'd condone that of course.

Ditto when my first beloved dog was in a lot of pain, me lying on the floor beside him & in contact with him seemed to help him rest.

Contact, especially with the back is soothing & it's instinctive. When a young niece was a toddler and upset I would instinctively stroke her back. Just as my parents did with me.

This is nothing new.

This "binding" business.....no, not really.

Think of all the elderly in care homes who missed physical contact with their families, just a hug or holding hands. I'm sure they all imagined what it would be like to do so again. Pretty sure imagining it, while mildly comforting, is nothing like the real thing.

Can we go back to actual medicine now, please?