Journal Article Annotations
2017, 2nd Quarter
Annotations by Sean Heffernan, MD
The finding: Nearly three quarters of fatigued patients with type I diabetes experience pain, specifically joint and muscle pain, headache, and low back pain. This figure includes both acute and chronic pain. Not all pain can be explained as a diabetes-related complication. Patients with diabetes, fatigue, and pain reported more depressive symptoms on BDI than those with diabetes and fatigue.
Strength and weaknesses: The major strength is that this study describes a large cohort of patients with similar comorbidities. Weaknesses include the lack of distinction between chronic and acute pain during survey, which was a self-report questionnaire done at a single time point. Also, the investigators did not clearly identify which pain complaints could be directly linked to diabetes. The subjects were not recruited for this study, but rather for a separate randomized control trial.
Relevance: This study highlights the importance of investigating pain complaints in subjects with type I diabetes, especially those with complaints of fatigue. Pain was associated with report of depressive symptoms, fatigue severity, and some functional impairment.
The finding: A systematic review and meta-analysis of 30 randomized control trials concludes that mindfulness meditation is associated with mild improvement in chronic pain and depressive symptoms when compared with treatment as usual, passive controls, and education/support groups. The authors note inconsistent effects and weakness in the body of evidence and therefore support a conservative view of this intervention.
Strength and weaknesses: The authors took a balanced and comprehensive approach to the literature, focusing on validity of study as they collected data. The limitations of this manuscript lie primarily in the weakness of the studies it included, which were compromised by small samples, poor follow-up, and poor reporting of methods.
Relevance: More well-designed and rigorous RCTs are needed to develop an evidence base from which we could collectively draw stronger conclusions about the role and effect of mindfulness meditation as a treatment for chronic pain.