Recent comments on treatment effectiveness research

[JayCeon]

Recent JAMA-comments on the fibromyalgia-treatment-meta-analysis:

In reply to a meta-analysis published Oct20 (224 trials, almost 30.000 patients)

jamanetwork.com/journals/ja...

a comment and response were published Mar21:

jamanetwork.com/journals/ja...

jamanetwork.com/journals/ja...

Correct me, but the gist seems to me to be that

1) meta-analysis of studies shows that there is small hard evidence that only CBT as well as antidepressants and central nervous system depressants may help a bit,

2) whilst "stepped care", a combination of treatments incl. meds (e.g. duloxetine plus pregabalin) do clinically seem more effective than single meds,

3) but the meta-analytical research does not show this effectiveness.

Also "interesting" that a comment under 1 by an MD from the Univ. of Utah insinuates that there is no real medical evidence that fibro is more than just ""pain" accompanying depression"! Would it be prejudiced to assume that this university is generally "old-fashioned"? O.o

[desquinn Partner Volunteer FMAUK Trustee]

this corresponds with Eulars review as well and you will probably see in theirs that it says "current evidence is lacking for most therapies / currently available therapies for the management of fibromyalgia are not supported by high-quality evidence" also or similar.

That comment is maybe not reflective of his medical alma mater but the lack of continuing education standard he has put himself through? Maybe the MD is old fashioned.

You may be interested in this video which has a comedic element to it so beware but watch and enjoy. facebook.com/watch/?v=10157...

[desquinn Partner Volunteer FMAUK Trustee in reply to desquinn]

coming back to this as I ready the other links and the one from Clauw (which means it is worth reading ) has an important point to make - jamanetwork.com/journals/ja...

I could pull out the whole note and post it as it was relevant but I think the below helps. Also, I am not aware of anyone doing RCTs on layered approaches as it would be very challenging and expensive most likely. This and the lack of good evidence starts to make more sense.

"There is mounting evidence for this approach; for example, there are higher overall response rates in patients with fibromyalgia who are treated with a serotonin-norepinephrine reuptake inhibitor and an α2δ-subunit calcium channel ligand together, than with either alone.2 Similarly, there are greater reductions in pain for patients receiving duloxetine plus pregabalin than for those receiving either alone.3 "

Will try and get the full text to have a read.

[JayCeon in reply to desquinn]

Great, laughing my head off! - it's here too youtu.be/vmWRsVxGjpQ9(Not working as expected?) Reasons To Blame The Recession on Fibromyalgia (Thanks Clickbait Generator) | Incident Report 094

I like the suggestion that women are "a little more in tune with what they are experiencing". Prefer this to saying as at least one study (altho at least one female doc took part) does that women "castrofyze" their pain. ncbi.nlm.nih.gov/pubmed/222...

29th min.: combination of meds, as said above, so "cutting edge semi-comedy"

42nd min: According to him, talking of it as a waste paper basket diagnosis implies it's being overdiagnosed. So let's remember not to hawk that talk!!

Love it, thanks!

[desquinn Partner Volunteer FMAUK Trustee in reply to JayCeon]

catastrophizing will be present in a lot of people irrespective to gender. He did a recent hourlong one with Dr Rachael Zoffness that is worth watching. She will potentially come back and do something specifically on fibro / cfs

I like zdogg for how he cuts through science and puts another perspective on things. Often with humour but also the inclusion of subject experts is great. The episode with Dr Monica Ghandi (Ward 86 - Aids - San francisco / infection disease specialist) is worth watching as well albeit not relevant to fibro.

[Cat00 in reply to desquinn]

Fantastic video, really cheered me up after no sleep and difficult kung fu class last night. I'm always doubting my diagnosis stuff like this helps. Mini Trumps a nice touch too.