RNZCGP GoodFellow Unit MedCases CPD Sept 2023: Chronic fatigue syndrome/myalgic encephalomyelitis

Discussion in 'Psychosomatic news - ME/CFS and Long Covid' started by SNT Gatchaman, Sep 20, 2023.

  1. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    https://www.goodfellowunit.org/medcases/chronic-fatigue-syndromemyalgic-encephalomyelitis

    Chronic fatigue syndrome/myalgic encephalomyelitis
    Date Published
    Monday, 18 September 2023
    Category
    Chronic conditions

    Miss C is a 17-year-old girl who comes to see you ...

    The specific treatments that can help include:
    1. Cognitive Behavioural Therapy (CBT).
    2. Graded exercise
    3. Lightning Process (for children 12 to 18). There is encouraging evidence from a small RCT in children.4 It has also been used successfully in young adults but has not been studied in RCTs in older age groups.
    Activity pacing, where participants are not asked to increase activity beyond their current perceived energy envelope, has not been shown to be effective for fatigue reduction in large trials and systematic reviews.1,3 Part of the problem may be that pacing has been very variably defined: in the large PACE trial, 3 which was negative, participants were asked to limit their exercise to 70% of their perceived energy envelope; other trials that suggest there may be benefit have used higher figures and/or included co-interventions.1 With the above caveats about how to define pacing, there is limited trial evidence that pacing may increase physical functioning and reduce depression and anxiety.1

    Graded exercise on the other hand, where patients are encouraged to increase their activity beyond current functioning, has been much more clearly shown to be effective for both fatigue and physical functioning,1,3 and CBT also has a solid evidence base.

    Post-exercise malaise; This is the most feared symptom of many patients with CFS/ME. There was reduced post-exercise malaise in the CBT and GE groups in the PACE trial.3 The fact that CBT can help does not imply that the condition has a psychological cause.

    ---
    This MedCase was written by Professor Bruce Arroll, General Practitioner, with review by Professor Paul Little of Primary Care Research at the University of Southampton UK.

    References
    1. The effectiveness of activity pacing interventions for people with chronic fatigue syndrome: a systematic review and meta-analysis. Disabil Rehabil. (2022)
    2. Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis J Neurol Neurosurg Psychiatry. (2023)
    3. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. (2011)
    4. Clinical and cost-effectiveness of the Lightning Process in addition to specialist medical care for paediatric chronic fatigue syndrome: randomised controlled trial. Arch Dis Child. (2018)
     
    Last edited: Sep 20, 2023
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  2. NelliePledge

    NelliePledge Moderator Staff Member

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  3. Ravn

    Ravn Senior Member (Voting Rights)

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  4. Hutan

    Hutan Moderator Staff Member

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    Oh SNT, that is so dispiriting. Horrendous misinformation.

    Is there anything we can do?
     
    Last edited: Sep 20, 2023
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  5. Hutan

    Hutan Moderator Staff Member

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    It's mostly an ad for the Lightning Process.
     
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  6. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    "Siri, what is oppositional defiant disorder?" Except in this case it's one authority figure defying another (NICE / IOM / Science).

    I don't know, it hardly seems worth appealing to the publishing organisation when the author of this tripe is the director of that organisation...

    Have to laugh at his comments here

    Bruce - mate - hate to tell you, but you're the senior man who knows nothing, literally.
     
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  7. NelliePledge

    NelliePledge Moderator Staff Member

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    What is the connection between the royal college and this Goodfellow Unit I couldn’t find about us info. All there.seems to be is a logo
     
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  8. Hutan

    Hutan Moderator Staff Member

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    :D

    I reckon it could be worth writing to them - there is a contact form. There's a bit to say -
    NICE guidelines:
    rating the outcomes of the PACE trial as being low to very low quality evidence;
    explicitly warning against the Lightning Process and GET;
    the fact that the PACE trial was not a sound study of pacing, as the Adaptive Pacing treatment was not pacing. Pacing is an approach that most people with ME/CFS come to adopt given time, limiting activity so as to avoid post-exertional malaise - most of the participants in the PACE trial would have already been pacing at the baseline.

    CDC rejection of GET

    The Lightning Process - background of the founder, high cost, MLM approach, Flaws in the Crawley study

    The recognition by Cochrane that their 2019 Exercise therapy for CFS is not fit for purpose.

    The repudiation of virtually all ME/CFS organisations around the world of graded exercise therapy as a treatment of ME/CFS.

    Perhaps linking to the comments on the Cochrane petition (although it gets hard to explain what we are petitioning Cochrane for)


    Yes, it would help to find the Board or some organisation the Goodfellow Unit is answerable to.
     
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  9. Hutan

    Hutan Moderator Staff Member

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    So, the School of Population Health at the University of Auckland might be the target of a letter.
     
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  10. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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  11. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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  12. Hutan

    Hutan Moderator Staff Member

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    I note that Professor Paula Lorgelly is a faculty member of the School of Population Health at the University of Auckland. She was instrumental in setting up Long covid Registry. She seems to have sensible ideas about post-viral conditions. Maybe the School of Population health is the organisation to target.

    How on earth did Bruce Arroll get appointed as Director of the Goodfellow Unit?
    https://www.brucearroll.com/resources

    https://www.nzdoctor.co.nz/article/news/lightning-process-rewiring-brain
    Lightning Process coach Jenny Oliver speaking at the Goodfellow Symposium in March 2023

    Bruce Arrow replied to Ros Vallings' very tame suggestion that the Lightning Process wasn't an ME/CFS treatment with this, coauthored with the NZ champion of the Lightning Process, Jenny Oliver:

    There's more than a whiff of vested interest here.

    On that same NZ Doctor site, the RNZCGP is suggesting that having Arroll chair Jenny Oliver's workshops on LP at the GPCME conference ensured balance...
     
    Last edited: Sep 20, 2023
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  13. Trish

    Trish Moderator Staff Member

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    It is concerning how dogmatically convinced Dr Arroll is in his misinformation. I can't understand how anyone can be so one sided unless they have a personal vested interest, or have no clue about ME/CFS and research methodology.

    It would be an interesting study finding out how individual clinicians reach such unswerving conviction that they are right when the 'evidence' is so biased.

    At what stage in their career do they decide who and what to believe, and can they ever change their view?
     
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  14. Hutan

    Hutan Moderator Staff Member

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    Heaven help us. The Association for Neuro Linguistic Programming (NLP) featured Bruce Arroll instructing on designing RCTs in 2015.
    https://anlp.org/rapport/read/lite/rapport-48-winter-2015

    I assume it's the same Bruce Arroll. Because here in 2016 he was presenting at the NZ GP's conference:
    http://www.gpcme.co.nz/pdf/2016 North/Fri_room6_1400_Arroll NLP ws 42 & 54 fridasy 1400.pdf
    Professor Bruce Arroll
    Department of General Practice and Primary Health Care
    University of Auckland
    14:00 - 14:55 WS #42: Practical Uses of Neurolinguistic Programming in Primary Care
    15:05 - 16:00 WS #54: Practical Uses of Neurolinguistic Programming in Primary Care (Repeated)

    I think we have the answer as to why the Lightning Process has been all over the NZ GP conferences.
     
    Last edited: Sep 20, 2023
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  15. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    Have to answer these in memes I'm sorry :)

    450d07de956eb0d752cd842d7eebfe6ed99cdbfae07661db89eaf1457fce1abc_1 Medium.jpeg

    4421268.jpg
     
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  16. Hutan

    Hutan Moderator Staff Member

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  17. obeat

    obeat Senior Member (Voting Rights)

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    EBM=exceptionally bossy medicine
     
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  18. Trish

    Trish Moderator Staff Member

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    EBM = Extraordinarily Batshit-crazy Medicine.
    It would be funny if it weren't for the shocking amount of harm it causes.

    Reading this in the same week as all the hundreds of messages on our petition with personal testimonies of lives ruined by GET, and hearing of cases of malnutrition not being treated and death makes it seem criminally negligent.

    I'm left feeling helpless with rage, only I don't have any energy for rage, so I'm left with immense sadness.

    And a determination to fight on.
     
  19. Hutan

    Hutan Moderator Staff Member

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  20. dave30th

    dave30th Senior Member (Voting Rights)

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    where is her letter? can someone post it?
     
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