The challenges of chronic pain and fatigue, Eccles and Davies, 2021

Open access, https://www.rcpjournals.org/content/clinmedicine/21/1/19

 

The authors suggest considering problems with connective tissue (joint hypermobility), small fibre neuropathy, mast cell activation in patients with pain and fatigue.

On the hand, they propose a multidisciplinary model based on the biopsychosocial approach and referral to a health psychologist. The ideal response in box 4 includes a graded exercise program by a physiotherapist. The authors also suggest considering 'interoceptive processing':

The authors also propose that their approach is more cost-effective because referral to specialist may lead to expensive and unnecessary investigations. they write:

This looks like a weird combination of the biomedical and psychosomatic model of ME/CFS. What holds it together is that it is a collection of unsupported theories about people with fatigue and pain. They all give the impression that Eccles and Davies know more about pain and fatigue and what to do about it, than their colleagues - while they probably don't. It seems like the opposite of saying "we don't know yet".

I hope I'm not being too harsh but I'm not a fan of this approach. Interested in hearing what others think

 

Why do we see in this area a rush to produce clinical interventions based on pet theories, without any adequate investigation as to whether there is any evidence for that pet theory or if it is pure fantasy?

Because something is a logical possibility does not mean it is a reasonably fancy.

 

Absolutely agree, this is a most weird and internally contradictory approach. A sort of BPS pastiche.
Maybe rather than BPS it is BSP (bromsulphthalein if I remember rightly) or PBS (phosphate buffered saline) or SPB (a general term for societies for the protection of birds)??

Or maybe it is just a reincarnation of Eccles himself.
'How do you know it is half past eight , Eccles.' (Bluebottle voice.)
'I got it written down on a piece of paper.'

About the level.

 

https://twitter.com/user/status/1371413677014933505

 

So...if I am in pain, but they decide, on their prefered basis of no investigations/evidence, that I am not, that I am wrong, and that I obviously need reeducating until I say I am no longer in pain?

If only other things could be done this way.

'Multiple pile vehicle pile up, many injured and dead, send ambulances.'

'I don't think so, there is no evidence.'

'I've got video!!!'

'I've told you that there was no accident, and as a professional I would know if there was, yet you persist in your delusions, you're clearly suffering from a maladaptive obsession - we have CBT for that.'

Just think of the savings.

 

Oops, that doesn't do much for the reputation the Academy of Medical Sciences.

 

Right......I wonder why that could be?

Not being able to fall asleep &, when you do, waking up frequently because of the pain, waking early etc. does tend to make people very tired.

Not just tired of being in pain tired but tired, tired.

Honestly, will this BS never end?

 

And I thought I was good at creative writing at school......

 

Well at least they're better than this guy

Functional disorders and chronic pain
Richard Sawyer
https://www.rcpjournals.org/content/clinmedicine/21/2/e242.2

Response
Jessica A Eccles and Kevin A Davies
https://www.rcpjournals.org/content/clinmedicine/21/2/e243.1