..an innovative multi-component long COVID treatment program based on central sensitization with preliminary patient satisfaction data 2024 Munipalli+

[Andy]

Full title: A description of the development of an innovative multi-component long COVID treatment program based on central sensitization with preliminary patient satisfaction data

Highlights

• Long COVID is the persistence of COVID-19 symptoms for >3 months without an alternative diagnosis.
  
  
• Long COVID impacts quality of life, the ability to return to work, and personal health.
  
  
• Central Sensitization is a primary mechanism for the development of Long COVID symptoms.
  
  
• Cognitive Behavioral Therapy may benefit Long COVID Central Sensitization.

Abstract

Objective
Estimates of the prevalence of Long COVID in the United States or worldwide are imprecise, but millions of people are thought to be affected. No effective treatment exists for the often devastating symptoms of Long COVID. Central Sensitization has been postulated as a causal/explanatory mechanism for developing Long COVID. No treatment to date has targeted Central Sensitization. The present cross-sectional study describes the first 140 patients treated in a multi-component treatment program that targets Central Sensitization to reduce symptom burden, improve functioning, and lower the psychological distress observed in these patients.

Methods
140 patients diagnosed with Long COVID after an extensive medical evaluation were assessed for function, depression, and pain catastrophizing using questionnaires and patient satisfaction measures after completion of a 16-h Cognitive Behavioral Therapy treatment program focused on Central Sensitization.

Results
Upon admission, patients diagnosed with Long COVID were significantly impaired in their ability to function due to their symptoms. Further, 70% of the patients were depressed. Pain catastrophizing was observed in up to 20% of patients.

Conclusion
Patient satisfaction measures were high for the sample at the end of the treatment program suggesting that a multicomponent treatment program targeting Central Sensitization is acceptable to patients. Further research is needed to explore the effectiveness and durability of this treatment approach.

Paywall with section 'snippets', https://www.sciencedirect.com/science/article/abs/pii/S0022399924002964

 

[Amw66]

So let me guess- questionnaires and no objective outcomes ?

 

[Turtle]

Two whole days of training? + travel?
After two whole days how many of us would be able to answer any question at all?

 

[rvallee]

It's odd how they keep using words like 'innovative' and 'novel' for the same old recycled garbage. I guess they understand that to suggest something, it has to be different from what's out there, since it's known that there are no effective treatments, so they tack on fake labels on the same old stuff. It starts as marketing and ends as marketing. Nothing else in-between.

Also weird how they only care about patient satisfaction when it suits them, and completely dismiss the entire concept when it comes to tens of thousands of reports of harm. Although it must have taken quite the selection process for that, since this is almost universally dismissed as kooky gaslighting nonsense.

Central Sensitization is a primary mechanism for the development of Long COVID symptoms.

And how can an academic journal allow this statement in a highlight section? Seriously have they just completely stopped bothering to do their job? This isn't even a hypothesis, it's a buzzword opinion without any substance.

But the oddest thing is the complete absence of any actual data in the results. And two very odd sentences.

Good grief this is mediocre.

 

[Hutan]

Good grief this is mediocre.

It really is.

And count the, well, what do we call them? Lies? Evidence of deluded thinking? Misrepresentations?

1. "Innovative" - nope, just the same old stuff

2. "Central Sensitization is a primary mechanism for the development of Long COVID symptoms." - no, there is no evidence that allows such a definitive statement to be made. The highlights and abstract aren't even internally consistent - the abstract says "Central Sensitization has been postulated as a causal/explanatory mechanism for developing Long COVID." So, a postulation in the abstract has been turned into a definitive 'primary mechanism' in the Highlights.

3. "Cognitive Behavioral Therapy may benefit Long COVID Central Sensitization." - not exactly a misstatement, more 'cart before the horse'. See 2. - no evidence that 'Long Covid Central Sensitisation' is a thing. And no evidence from this study that CBT benefits it.

4. "No treatment to date has targeted Central Sensitization." - ridiculous. We've seen plenty of trials of CBT and similar 'think your way to health' approaches.


More evidence of mediocrity:
1. Methods

Methods
140 patients diagnosed with Long COVID after an extensive medical evaluation were assessed for function, depression, and pain catastrophizing using questionnaires and patient satisfaction measures after completion of a 16-h Cognitive Behavioral Therapy treatment program focused on Central Sensitization.

The Methods Section only refers to assessments after completion of the CBT programme - there's no indication that there were baseline assessments. They don't indicate if any of the assessments were objective.

2. Results

Results
Upon admission, patients diagnosed with Long COVID were significantly impaired in their ability to function due to their symptoms. Further, 70% of the patients were depressed. Pain catastrophizing was observed in up to 20% of patients.

Weirdly, the Results section only talks about assessments before the CBT programme! Even though the Methods section only talks about assessments after the CBT programme. And even though that means that they have given us no results for the treatment, not even about the 'preliminary patient satisfaction data' promised in the title.

The statements about depression and pain catastrophising are likely to be very questionable; I'd be willing to bet that the tools used are problematic for people with ME/CFS-type illness.

3. Conclusions

Conclusion
Patient satisfaction measures were high for the sample at the end of the treatment program suggesting that a multicomponent treatment program targeting Central Sensitization is acceptable to patients. Further research is needed to explore the effectiveness and durability of this treatment approach.

Having given us no data about patient satisfaction in Results, the Conclusion suddenly asserts that 'patients satisfaction measures' were high. Note that the assessment point was only at the end of the treatment programme, and it's likely that the patients were told that ongoing practice would bring benefits. Remember, the treatment programme was only 16 hours (2 days). So, patient satisfaction at that point doesn't mean much.

They can't be concluding that this 'multicomponent treatment program ... is acceptable to patients' while saying that future research is needed to 'explore effectiveness and durability' of benefits of the treatment approach. If it doesn't work, it won't be acceptable to people with Long Covid.

I can't sum it up better than that sentence by @rvallee again

Good grief this is mediocre.

 

[Amw66]

It really is.

And count the, well, what do we call them? Lies? Evidence of deluded thinking? Misrepresentations?

1. "Innovative" - nope, just the same old stuff

2. "Central Sensitization is a primary mechanism for the development of Long COVID symptoms." - no, there is no evidence that allows such a definitive statement to be made. The highlights and abstract aren't even internally consistent - the abstract says "Central Sensitization has been postulated as a causal/explanatory mechanism for developing Long COVID." So, a postulation in the abstract has been turned into a definitive 'primary mechanism' in the Highlights.

3. "Cognitive Behavioral Therapy may benefit Long COVID Central Sensitization." - not exactly a misstatement, more 'cart before the horse'. See 2. - no evidence that 'Long Covid Central Sensitisation' is a thing. And no evidence from this study that CBT benefits it.

4. "No treatment to date has targeted Central Sensitization." - ridiculous. We've seen plenty of trials of CBT and similar 'think your way to health' approaches.


More evidence of mediocrity:
1. Methods

The Methods Section only refers to assessments after completion of the CBT programme - there's no indication that there were baseline assessments. They don't indicate if any of the assessments were objective.

2. Results

Weirdly, the Results section only talks about assessments before the CBT programme! Even though the Methods section only talks about assessments after the CBT programme. And even though that means that they have given us no results for the treatment, not even about the 'preliminary patient satisfaction data' promised in the title.

The statements about depression and pain catastrophising are likely to be very questionable; I'd be willing to bet that the tools used are problematic for people with ME/CFS-type illness.

3. Conclusions

Having given us no data about patient satisfaction in Results, the Conclusion suddenly asserts that 'patients satisfaction measures' were high. Note that the assessment point was only at the end of the treatment programme, and it's likely that the patients were told that ongoing practice would bring benefits. Remember, the treatment programme was only 16 hours. So, patient satisfaction at that point doesn't mean much.

They can't be concluding that this 'multicomponent treatment program ... is acceptable to patients' while saying that future research is needed to 'explore effectiveness and durability' of benefits of the treatment approach. If it doesn't work, it won't be acceptable to people with Long Covid.

I can't sum it up better than that sentence by @rvallee again

Mediocre is being generous

 

[SNT Gatchaman]

So let me guess- questionnaires and no objective outcomes ?

Sounds like it: "follow-up data is being gathered" not "has been recorded and is being analysed".

Questionnaires that assessed functioning, depression, and pain catastrophizing were completed before beginning the 2-day program. Patient satisfaction was evaluated upon completion of the program. Follow-up data is being gathered to determine the effectiveness of the intervention.

2.2. Measures
The Symptom Impact Questionnaire Revised (SIQR) is a 21-question self-report questionnaire designed to measure function, overall impact, and symptoms in adults.

Questions are scored from 0 to 10, with 0 being the best and 10 being the worst. The total score ranges from 0 to 100. The higher the total score, the higher the impact of symptoms.

Depression was assessed with the Center for Epidemiologic Studies of Depression (CES

D) scale. It is a 20-question self-report scale that was designed to measure depressive symptoms in the general population. Response scores range from 0 to 3 depending on the frequency of symptom occurrence for the week prior. Total score ranges from 0 to 60, with 0 being the best possible and 60 being the worst possible. A cut-off score of 16 or more indicates depression.

The Pain Catastrophizing Scale (PCS) is a 13-question self-report scale designed to measure catastrophic thinking related to pain in adults. Response scores range from 0 to 4, with 0 being not at all and 4 being all the time, depending on symptom occurrence for the week prior. Total score ranges from 0 to 52, with 0 being best possible and 52 being worst possible. Scores of 30 or more indicate a clinically relevant level of catastrophizing that has been linked to poor outcomes in patients with pain disorders and has been noted to be one of the most potent predictors impacting outcomes in patients with pain.

2.3. Patient satisfaction
Patient satisfaction was assessed anonymously at the end of the 2-day treatment program with a self-administered questionnaire that assessed global domains of satisfaction with the program.

 

[SNT Gatchaman]

It's possible that this 2 day course / innovative multi-component treatment program is the Lightning Process. Excluding the pre-intervention patient parameters, here's the entirety of the results, although "The full patient satisfaction scale is included in the supplementary material."

Wait for it —

 

[SNT Gatchaman]

It isn't the LP per se but it might as well be, it sounds "informed" by it —

The program is a 16-h group-based multi-component class that targets the symptoms of Central Sensitization experienced by patients with Long COVID. Topics covered include the pathophysiology of Long COVID and Central Sensitization, and lifestyle management focusing on Cognitive Behavioral strategies that decrease symptoms, improve functioning, and reduce psychological distress. Strategies taught include relaxation practices, graded exercise, sleep hygiene, moderation, activity pacing, and healthy nutrition to combat fatigue.

Relaxation practices that assist with self-regulation include deep diaphragmic breathing, mindfulness sensory exploration practice, passive muscle relaxation, progressive muscle relaxation, imagery/visualization, meditation, yoga, and tai chi. Returning to day-to-day movement through graded exercise includes three components: stretching daily, strengthening twice a week, and building up to 30 min of moderate aerobic conditioning.

Sleep Hygiene focuses on creating a bedtime routine, maintaining consistent wake time and bedtime, having no screen time before bed, regular exercise, no naps, a cool, dark, and quiet sleep environment, and no clock watching. Moderation and activity pacing by changing positions throughout the day, prioritizing takes, delegation, and alternating between physical and non-physical activities every 45 min – 1 h.

Healthy nutrition to address fatigue includes eating several small meals throughout the day, limiting caffeine to 1–2 cups before noon, and drinking more water. Stress management and the importance of social support and decreasing social isolation were reviewed. Stress reduction strategies include prioritizing self-care, simplifying the schedule, improving sleep, exercising, delegating, having fun, relaxing, and spending time with positive, supportive people. Mood and anxiety were also addressed through strategies for targeting maladaptive cognition, such as pain catastrophizing. Patients developed a plan that incorporates consistent implementation of these Cognitive Behavioral strategies daily to develop new habits and ways of thinking. Family members are encouraged to attend to improve patient support as they build this plan to manage their symptoms better.

The program was developed in a joint effort between the Division of General Internal Medicine Post-acute Sequelae of COVID-19 (PASC) clinic and the Department of Psychiatry and Psychology at an extensive tertiary medical practice. The program design was modeled after the medical practice's Fibromyalgia Treatment Program that focuses on Cognitive Behavioral strategies to decrease Central Sensitization. A health psychologist and Licensed Clinical Social Workers facilitated all program components. The information and strategies taught in the program are also incorporated into a format that can be shared with the patient's primary medical provider to help build additional support for using these tools going forward.

 

[rvallee]

4. "No treatment to date has targeted Central Sensitization." - ridiculous. We've seen plenty of trials of CBT and similar 'think your way to health' approaches.

I assume that they mean here in the case of Long Covid. Which isn't even true, but whatever that never stops them. It's long been a strategy, that, yes, something like this has been tried dozens, possibly hundreds of times before, but not on a Tuesday following the grape harvest in the region of Toulouse involving patients who have a bit of receding baldness but also a taste for chocolate ice cream.

They basically rely on infinite permutations to keep doing the same thing slightly differently, for no other reason that they simply don't know how to do anything useful and this is just easy funding for papers that pads their academic résumé.

In essence, exactly this joke by Emo Philips:

"Once I saw this guy on a bridge about to jump. I said, "Don't do it!" He said, "Nobody loves me." I said, "God loves you. Do you believe in God?"

He said, "Yes." I said, "Are you a Christian or a Jew?" He said, "A Christian." I said, "Me, too! Protestant or Catholic?" He said, "Protestant." I said, "Me, too! What franchise?" He said, "Baptist." I said, "Me, too! Northern Baptist or Southern Baptist?" He said, "Northern Baptist." I said, "Me, too! Northern Conservative Baptist or Northern Liberal Baptist?"

He said, "Northern Conservative Baptist." I said, "Me, too! Northern Conservative Baptist Great Lakes Region, or Northern Conservative Baptist Eastern Region?" He said, "Northern Conservative Baptist Great Lakes Region." I said, "Me, too!"

Northern Conservative Baptist Great Lakes Region Council of 1879, or Northern Conservative Baptist Great Lakes Region Council of 1912?" He said, "Northern Conservative Baptist Great Lakes Region Council of 1912." I said, "Die, heretic!" And I pushed him over."​

 

[rvallee]

So, patient satisfaction at that point doesn't mean much.

Randomly reminds me of how Cybertruck owners are generally ecstatic about their new purchase. For a few days. Only for a few days. Then reality sinks in that they bought a massively expensive lemon, but no backsies.

 

[Sean]

There is crap. And then there is something like this, which makes the standard crap look and smell good.

Maybe that is its purpose.

 

[Hutan]

You might think that perhaps the authors live in some part of the world that is under-resourced, where a "multi-component long COVID treatment program based on central sensitization" hasn't been tried before and where they have not had the benefit of exposure to informed ME/CFS and Long Covid patient advocates - edit - and sound research methodology. I did. But, no, not at all. Most of the authors come from the Mayo Clinic.

B. Munipalli a; B. Smith b; A. R. Baird c, d; C. S. Dobrowolski c, d; M.E. Allman e; L. G. Thomas f; B.K. Bruce d
a Division of General Internal Medicine, Mayo Clinic, Florida, USA
b Department of Psychology, University of North Florida, USA
c Section of Social Work, Mayo Clinic, Florida, USA
d Department of Psychiatry and Psychology, Mayo Clinic, Florida, USA
e Department of Psychology, University of Houston, USA
f Psychology Department, Trinity College, Hartford, CT, USA

 

[Turtle]

These "researchers" should never come close to patients again. I'd rather have them arrested for patient abuse and fraude.