An Integrative Neuropsychological Approach to Chronic Pain, Emotions and Clinical Symptoms, 2022, Montoro and Galvez-Sánchez

Straightforward case of mis-attribution of causality.

115 women with fibromyalgia, recruited from the Fibromyalgia Association of Jaén (AFIXA; Spain) (I've said it before, where is the responsibility in patient organisations that encourage their members to put themselves in harm's way, facilitate it even?)



Lots of questionnaires:
Fibromyalgia Impact Questionnaire (FIQ)
10 items that evaluates functional domains affected in FMS patients (e.g., problems with muscle tasks, problems with work, pain, fatigue, stiffness, depression, anxiety, and morning tiredness). The first item of the FIQ (i.e., the physical impairment subscale) is further divided into several sub-items. The maximum possible score of each item is 10. The final score ranges in a continuum between 0 and 100.


McGill Pain Questionnaire (MPQ)
State-Trait Anxiety Inventory (STAI)
Beck Depression Inventory (BDI)
Fatigue Severity Scale (FSS)
Oviedo Quality of Sleep Questionnaire (COS)
Coping Strategies Questionnaire (CSQ)

Lots of data points, lots of opportunities to find something.




Trait anxiety
First, let's note that the Fibromyalgia Impact Questionnaire (FIQ) measures anxiety, among other things such as problems functioning, and fatigue, and morning tiredness.

Second, the authors aren't claiming any correlation with state anxiety, only trait anxiety, which seems odd if anxiety was causing fibromyalgia

Third, the questions about trait anxiety in the State/Trait Anxiety Inventory include:
Questions that a person with fatigue will score poorly on e.g. *I feel rested; *I tire easily;
Questions that a person with a chronic illness that prevents them from living the life they want is likely to score poorly on e.g. *I felt satisfied with myself, * I feel like a failure, *I am happy, *I lack self-confidence, *I feel inadequate, *I feel content
Questions that are legitimate concerns for someone who is struggling to earn a living e.g. *I feel that difficulties are piling up
Questions about anxiety e.g. I worry too much over something.

So, the FIQ which partly measures anxiety is correlated with the State Anxiety Inventory questionnaire that partly measures anxiety. Not surprising.
The FIQ which partly measures fatigue, is correlated with the SAI that partly measures fatigue
The FIQ, which partly measures illness impact, is correlated with the SAI that measures how people feel about not being able to live the life they expected to be able to live, and how they feel about real difficulties.

It's entirely circular. The association is largely due to the surveys asking the same things (and not entirely the things you would expect from the survey titles). It's also due to issues that anyone with a chronic debilitating health condition, especially a stigmatised one, faces, causing sadness and worry.

I could go through the other associations that were found positive, but the issues will be similar.

A BMI of 28.15 is in the overweight range - it does not indicate obesity. The mean age of the women was 52, BMI's in this range are not unusual.

It's nasty, patient-blaming stuff. And the treatments aren't about making life easier but instead about encouraging acceptance.

(A few edits to make things clearer.)

 

Casandra Isabel Montoro Aguilar
Good grief, this woman is certainly prolific. Someone, stop giving her patients to play with.

2022 papers so far (yes, 12, and that's not counting this latest one)

• Algometry for the assessment of central sensitisation to pain in fibromyalgia patients: a systematic review
• Central nervous activity during an emotional Stroop task in fibromyalgia syndrome
• Personality, Intervention and Psychological Treatment: Untangling and Explaining New Horizons and Perspectives
• The Mediating Role of Depression and Pain Catastrophizing in the Relationship between Functional Capacity and Pain Intensity in Patients with Fibromyalgia
• Variability of Reaction Time as a Marker of Executive Function Impairments in Fibromyalgia
• Chronic Pain: Clinical Updates and Perspectives
• Fibromyalgia Syndrome and Cognitive Decline: The Role of Body Mass Index and Clinical Symptoms
• Chronic Pain and Emotional Stroop: A Systematic Review
• Central Nervous Activity during a Dot Probe Task with Facial Expressions in Fibromyalgia
• Narcissistic Personality and Its Relationship with Post-Traumatic Symptoms and Emotional Factors: Results of a Mediational Analysis Aimed at Personalizing Mental Health Treatment
• The Link between Fibromyalgia Syndrome and Anger: A Systematic Review Revealing Research Gaps
• Migraine and Neuroticism: A Scoping Review

And here's the last one from 2021, just because it seems to sum up the aim behind a lot of her work:

• Personalized behavior management as a replacement for medications for pain control and mood regulation

 

I agree wholeheartedly with members' commentary on this. It is truly nasty stuff, patient blaming, lacking in understanding of the effects of pain, or empathy, misusing correlations to imply causations the wrong way around.
An absolutely classic and powerful case of medical gaslighting. It's tragic such mistreatment is allowed and even lauded by a large subset of the medical establishment and it's so widespread.

Surely anyone looking at this from a biomedical field should be able to see immediately that this research is bogus. Using overlapping questionnaires will inevitably lead to correlations, as Hutan has spelled out, and even if they didn't overlap, any correlation between pain and low mood or anxiety is likely to be the traumatic and life changing effect on mood of being in constant severe pain, and that the way to treat this, as shak8 says, is to try provide more effective pain killing medications.

 

Patient groups might have had a fair excuse before translations facilities on the internet. Now it's just a matter of running papers through some software.

The patient group helped these Spanish researchers source participants for the study, a lot of participants. Basic due diligence would require that they be aware of the work done previously by the researchers; I don't think there would be language barrier for that, and, if there was, then they could just ask the researchers for copies of papers in Spanish.

I think the only possible scenarios to explain how a patient charity could help serve up 115 women to these researchers are office holders who are either grossly incompetent and/or are fully captured by these BPS ideas. But, there's plenty of blame to go around and, yes, there should be some understanding too. Few, if any, of the people involved in this are truly evil, most will be thinking that they are helping people.

The BPS patient-blaming ideas thrive when people (researchers, research funders, patients and their families, politicians and more) are poorly educated in science, when systems for quality control in science are absent, when eminence is more importance than evidence, when misogeny goes unchallenged. The thriving of BPS ideas is a symptom of deeper problems in societies.

 

As we know the problem of patient groups being taken in by researchers with this agenda is pretty widespread internationally. And they have also gone as far as setting up ‘tame’ patient groups so they can guarantee compliance.

 

Just another example of humanity's endless search for simple, easy, cheap answers to complicated, difficult, expensive problems.