J Psychosom Res. A mean change in SF-36 physical function score of 10, 10, and 0 for standard, short and WLC groups, respectively, would increase power to 90%. 3. Assessments were made at baseline (0 weeks), just after randomization, at mid-therapy (13 weeks), post therapy (20 weeks/post-intervention), 4 weeks after booster (29 weeks), and 1 year after baseline (52 weeks). (2001) 286:13608. hmo0^0?%#UH@KWitIx)$(q5s Each follow-up time-point was added to the model as a dummy variable (i.e., 1013 weeks, 1821 weeks, 52 weeks and the baseline as a reference). Interpretation: A 16-week standard, individual CBT intervention improves physical function and fatigue in CFS outpatients with mild to moderate disease. BMC Med. In this study CFS means all these terms, according to the new ICD-11 classification (7). Psychiatry 12:580924. doi: 10.3389/fpsyt.2021.580924. Brief CBT-CP was developed to address the need for a brief, focused non-pharmacological intervention for chronic pain in primary care. %PDF-1.5 % 1TU0 Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo TM, Severens JL, et al. J Health Psychol. Lancet Psychiatry. J Chronic Fatigue Syndr. (2008) 28:73645. It assumes that treatment must be individualized to match the prominent personality style of the patient. To assess differences between intervention groups and the waiting-list group during follow-up, interaction terms between the group allocation and each registration time-point were included in the model. A decrease in insomnia severity reduces fatigue in chronic fatigue patients Free cognitive behavioral therapy Essays and Papers April 29th, 2018 - Free cognitive behavioral therapy papers (1993) 37:14753. Figure 3. Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group programme. There was a delay in registration of the trial in Clinical Trials (June 15, 2009), because the research group was not aware of the registration requirements at the time. doi: 10.1249/MSS.0b013e31817c92aa, 41. Federal government websites often end in .gov or .mil. The ideal would be to have a control period up to 1 year after baseline without intervention, but this was not possible due to ethical considerations. The cognitive behavioral model hypothesizes that it is not a situation in and of itself that determines what people feel and perceive, but rather the way in which they construe a situation which may influence the physical symptoms (43, 44). She has authored or edited 25 books and treatment manuals, many on cognitive behavioral therapy. J R Soc Med. Hence, measurements and comparisons were not made at the same number of weeks. This site needs JavaScript to work properly. Disclaimer: *Links will take you outside of the Department of Veterans Affairs Website. Factors That May Increase Pain Factors That May Decrease Pain Stress/worry/anxiety Exercising safely and using relaxation techniques Behaviors Too much (or too little) activity Pacing yourself When used in this way, the purpose of CBT isnt to treat or cure the underlying condition, but is an adjunctive therapy. The following main elements were included in the intervention: (a) information and explanation of the CFS symptoms based on contemporary knowledge on both physical and psychological components, (b) agreement on goals for the treatment (c) reading of self-help guides about how to cope with chronic fatigue (d) avoidance of excessive activity or rest and/or sudden change in activity, (e) planning of regular, predictable, continuous and graded activity to prohibit deconditioning, (f) recovering self-confidence and self-control by starting with a 5-min walk morning and night followed by gradual development (GET), and (g) standard CBT-procedures (47). Respectively, 52 (8%) and 40 (6%) patients were excluded because of somatic and psychiatric disorder. (2015) 43:14. It is based on a model of chronic fatigue syndrome (CFS) that hypothesizes that certain cognitions and behavior may perpetuate symptoms and disability--that is, act as obstacles to recovery. 2006 Oct;10(37):iii-iv, ix-x, 1-121. doi: 10.3310/hta10370. (2020): 'Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: Outcomes from a specialist clinic in the UK'. All patients who were enrolled and randomly allocated to treatment were included in the analysis and analyzed in the groups to which they were randomized (intention to treat/ITT) except the patients excluded for becoming pregnant during the trial (n = 4). In addition to the treatments in . Sharpe M, Goldsmith KA, Johnson AL, Chalder T, Walker J, White PD. The therapists also recorded events, if any, in the participants' journal. Standard CBT participants reported a statistically significant increase in their physical function compared to the WL control group, and reached a mean additional effect relative to baseline at post-intervention of 14.2 points, which exceeded the predefined MID improvement number of >10 (57). By understanding helpful strategies, it is possible to change ones pain experience, physically and emotionally. Amy Wenzel, PhD, ABPP, is a licensed clinical psychologist, owner and director of the Main Line Center for Evidence-Based Psychotherapy, faculty member at the Beck Institute for Cognitive Behavior Therapy, and certified trainer-consultant with the Academy of Cognitive Therapy. Secondary outcome was amongst others fatigue measured by Chalder Fatigue Questionnaire (CFQ) (033). Psychological medicine, 43(10), 2227-2235. sore throat or sore glands that arent swollen, problems thinking, remembering, concentrating, or planning, feeling dizzy or sick or having palpitations, exercising or concentrating on something makes your symptoms worse, Roche, Dawson, Moghaddam, Abey, and Gresswell (2017), Wiborg, Knoop, Frank, and Bleijenberg (2012). 30. (2002) 52:6977. A total of 110 of 132 patients (83.3%) diagnosed in this period were found to meet both the CDC 1994 and Canada 2003 criteria for CFS. All patients gave written consent to participate in the study. Exercise therapy for chronic fatigue syndrome. Many clients identify with the concept of stress more readily than threat and the The How Your Body Responds To Stressinformation handou Pacing is an evidence-based approach to increasing activity and fitness, and in reducing overall pain and fatigue. Preprint. -, Cella M, White PD, Sharpe M, et al. All measures were self-rated by the participants. Due to terminological variations and diagnostic inconsistencies, it is difficult to assess the prevalence and incidence rate of CFS in a population. Recovery from chronic fatigue syndrome after treatments given in the PACE trial. The finding that many of our participants reported minimal change at post-intervention and at the 1-year follow-up suggests that treatment effects can differ between subgroups. ncCVKk?x[{v4No/n'o?nfvZv~8pQ+U*WkS"UmX~u~4 WebCBT Instructor Manual - American Psychological Association ICD-10: WHO. (2007) 4:2837. Many different criteria sets are used to diagnose CFS, such as the Oxford and Sharpe 1991, CDC 1994, Reeves 2003, Canadian Consensus Criteria, NICE 2007, the International Consensus Criteria 2011 (8) and the systemic exertion intolerance disease, SEID criteria 2015 (2, 3). J R Soc Med. Psychoneuroendocrinology. (2015) 313:11012. (2011) 377:82336. This treatment manual is divided into several sections. Table 1. Visit her online and follow her on Facebook and Twitter. (2009) 30:28499. The effect differences between the CBT and I-CBT interventions at post-intervention could be explained by a time dosage-response effect, alternatively as a consequence of different contents in the two therapy modes. All baseline data and outcomes registered were analyzed for all three groups. Furthermore, 31% of the patients in the standard CBT group, 19% of the patients in the I-CBT group and 10% of the patients in the WLC- group reported normal fatigue scores related to the Norwegian population at the end of the waiting period (a fatigue score of 16.1 or less) (60). WebFrom Brief Cognitive Behavioral Therapy for Chronic Pain: Therapist Manual v 2.0 (Beehler, et al., 2021). doi: 10.1016/S2215-0366(15)00317-X, 21. WebChronic fatigue syndrome, also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), refers to long-standing severe and disabling fatigue without a proven physical or psychologic cause and without objective abnormalities found on physical examination or laboratory testing. (2005) 35:133748. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 3.2 p = 0.056 (95% CI 0.1 to 6.5)] groups revealed an unchanged, positive effect on physical function from post-intervention. Epub 2021 May 27. Table 4. Other secondary outcomes than fatigue were the remaining SF-36 measures/subscales of bodily pain; role physical and general health, vitality, social functioning, role emotional and mental health. 20):2233. Of the 626 patients assessed for eligibility, 581 (93%) completed medical and psychological examination, while 45 (7%) patients did not start or complete the assessment. Careers. 0.4 p = 0.35 (95%CI 1.5 to 2.3)] and I-CBT [diff. Retrieved from: http://www.sciencemediacentre.org/wp-content/uploads/2018/03/Science-Media-Centre-Factsheet-CFS-ME.pdf. 2021 Jun;114(6):284. doi: 10.1177/01410768211016791. CFS is not a form of mental illness, although of course individual cases may have a psychological component that At the 1-year follow-up, as many as 23% in the standard CBT group and 30% in the I-CBT group rated themselves as much better or very much better in overall health. The site is secure. There is limited knowledge of the natural time variation for CFS patients participating in clinical trials, but other studies with long term-follow-up after CBT for CFS show fairly sustained positive effects (20, 64). doi: 10.1016/j.csda.2015.02.012, 62. (2007) 187:714. In spite of that, a small review by Twisk et al. doi: 10.1017/S0033291705005210, 10. Curr Opin Pediatr. The 8 weeks of individual, interpersonal and personality-oriented CBT was given by four trained cognitive therapists at the private health centre Coperio, Trondheim, Norway. The therapists in both treatment groups registered the number of therapy sessions attended for each patient, active withdrawals from treatment, and dropouts from follow-up. Based on evidence from multiple Many of the strategies described in the manual are based on cognitive behaviour therapy, which has been shown to be effective in treating a wide range of problems, government site. Outcome data collection was completed on September 26, 2013. Twenty (8.5%) participants dropped out just after randomization and had only registered baseline data. Psychother Psychosom. doi: 10.1016/S0140-6736(06)68073-2, 2. It would be of interest to explore whether special characteristics can be found in patients who benefit from CBT, and thus indicate who should be referred to therapy with a prospect of improvement. The tests were primarily done for the purpose of identifying patients with CFS, but some of the test results will also be utilized in later articles generated from this study to answer relevant research questions. Our sincere appreciation goes to Inger Storaker, Ann-Elise Solvang, and Nina Groven for administering the tests to the patients and administering the trial at St Olavs Hospital, Trondheim, to Berit Bjelksen for support with scanning and organizing the data and to Lise T. Veium for administering the trial at the Coperio rehabilitation center in Trondheim, Norway. Table 5. Table 2. Busner J, Targum SD. endobj endstream endobj 92 0 obj <> endobj 93 0 obj <> endobj 94 0 obj <>stream We hypothesized that both standard CBT and I-CBT would have statistically significant effects on physical function as the primary outcome, as well as secondary outcomes e.g., fatigue, compared with the WLC group in CFS diagnosed with the Centre of Decease Control, CDC 1994 and Canada criteria (12, 37). Epub 2021 Apr 10. (2015) 2:106774. The VA Library Network will provide VA staff an index of recent articles related to opioids and many other areas of interest right to your work mailbox. Chronic fatigue syndrome. doi: 10.1016/S0140-6736(01)05424-1, 36. However, in this trial, regardless of cause, the patients show a lower dropout rate for I-CBT than standard CBT, which may indicate a better compliance in I-CBT. This study was a consecutive randomized controlled open-label trial with outcome assessed up to 52 weeks after baseline for patients meeting the CDC 1994 criteria (37) for CFS. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. White, P. D., Goldsmith, K., Johnson, A. L., Chalder, T., & Sharpe, M. (2013). (1993) 31:24763. If you are in crisis or having thoughts of suicide, Bookshelf (1998) 45:5365. doi: 10.1016/j.jpsychores.2017.03.016, Keywords: CFS, chronic fatigue syndrome, CBT, fatigue, physical function, myalgic encephalitis, Citation: Gotaas ME, Stiles TC, Bjrngaard JH, Borchgrevink PC and Fors EA (2021) Cognitive Behavioral Therapy Improves Physical Function and Fatigue in Mild and Moderate Chronic Fatigue Syndrome: A Consecutive Randomized Controlled Trial of Standard and Short Interventions. Exercise therapy for chronic fatigue syndrome. 44. Normal range for fatigue was defined as less than the mean plus 1 SD scores of the general Norwegian population of 12.2 (+3.9) (60). Salzer S, Winkelbach C, Leweke F, Leibing E, Leichsenring F. Long-term effects of short-term psychodynamic psychotherapy and. The etiology of CFS is largely unknown. The intervention consisted of 16 weekly sessions plus a booster session 4 weeks after the 16th session. doi: 10.1097/MOP.0b013e32835c1108, 15. JAMA. (2019). Both the primary and secondary outcomes were subjective in this study i.e., rated by the participants impressions. Cognitive behavioral therapy (CBT) is a psychological treatment that focuses on shifting unhelpful thinking or behavior patterns to more adaptive thinking or behavior patterns. Friendly and explanatory, they are co Our What Is ? series is a collection of one-page information handouts for common mental health conditions. doi: 10.1001/jama.2015.1346, PubMed Abstract | CrossRef Full Text | Google Scholar, 4. Cognitive-behavioral therapy for individuals with chronic pain: efficacy. Stulemeijer M, de Jong LW, Fiselier TJW, Hoogveld SWB, Bleijenberg G. Cognitive behaviour therapy for adolescents with chronic fatigue syndrome. This method uses all available information during follow-up and is less susceptible to bias from missing responses under the assumption of missing at random. Health Technol Assess. Thus, the WLC group was not scored at 1-year follow-up. Assessments were made at baseline (0 weeks), just after randomization, halfway through the waiting period (10 weeks), and at the end of the 16 weeks waiting period (18 weeks/post-intervention). All referrals to the clinic were screened by an experienced multidisciplinary team consisting of a doctor (general practitioner), a clinical psychologist or psychiatrist, a physical therapist, and a registered nurse. Please encourage Veterans with pain to take advantage of the accessibility of CBT-CP within VA. Share theCBT-CP Veteran Brochure (below) with your patients so they can learn more. J Public Health Med. A manual was given to participants, with treatment consisting of explanation, advice to avoid Cognitions, behaviours and co-morbid psychiatric diagnoses in patients with chronic fatigue syndrome. (2006) 367:34655. Self-help guide to recovery for chronic fatigue syndrome and fibromyalgia, CFS self-help information Cambridgeshire and Peterborough NHS, CFS/ME Self-Management Workbook | Torbay & South Devon CFS/ME Service, Managing Post-Exertional Malaise (PEM) | CDC. SMC was provided by clinicians with experience in chronic fatigue syndrome. No serious adverse events or reactions were recorded in any of the groups. Psychosomatics. Knoop H, van der Meer JW, Bleijenberg G. Guided self-instructions for people with chronic fatigue syndrome: randomised. I-CBT is a new form of treatment for CFS/ME. This product is out of stock, and cannot be ordered online at the moment. A shorter 8-week I-CBT program improves physical function. (2016) 59:112532. Ann Intern Med 1994; 121: 953959. (2012) 53:2507. If you are interested in subscribing to this alert click here. Psychol Med 2013; 43: 375380. The Department of Veterans Affairs (VA) offers Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) as an effective treatment for reducing the negative impacts of chronic pain on Veterans lives. Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR. doi: 10.1001/jama.286.11.1360, 32. Would you like email updates of new search results? The treatment was based on a biopsychosocial model (49) in which elements from interpersonal cognitive therapy (50) and personality-guided therapy (51) were integrated. Sullivan PF, Pedersen Nl Jacks A, Jacks A, Evengard B. 51. Kim DY, Lee JS, Park SY, Kim SJ, Son CG. Malouff JM, Thorsteinsson EB, Rooke SE, Bhullar N, Schutte NS. Differences for categorical variables, tested with Chi-squares show that there was a higher percentage of women in the standard group than the I-CBT group p < 0.05, but no significant difference in years of education p > 0.05 (Table 1). JB: statistics, calculations, figures and tables, and review of the text. Cognitive behavioral therapy and graded exercise are safe and moderately effective in patients with chronic fatigue syndrome, a large randomized trial suggests. 52. (2007) 30:7794. (1995) 98:41920. Blood samples were taken from each patient in accordance with the Norwegian Directorate of Health's requirement for assessing patients with suspected CFS (40), including numerous immunology, serology, and standard clinical chemical test (See Appendix S5). Participants in both treatment groups reported less fatigue than the control group and exceeded the defined MID on 3.0 points reduction in fatigue post-intervention 20 weeks from baseline (post-intervention). The primary outcome measure in this study was the SF-36 version 2 physical function subscale, one of eight subscales (53), presented as a so called mean difference, additional effect relative to baseline at post- intervention. In SF-36, raw score data are converted to a scale range of 0100, where the highest score reflects best self-rated function. Standard CBT also cause positive effects on fatigue. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. As with any human experience, CFS has a psychological component, which means that psychological approaches can form part of a support or treatment package for CFS/ME. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. Most of the evidence on the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome is from randomised control trials, but there are only a few studies in naturalistic treatment settings. 1. 97 0 obj <>/Filter/FlateDecode/ID[<5B983B51E8C7E21DD806A1F472D81130>]/Index[91 15]/Info 90 0 R/Length 51/Prev 58378/Root 92 0 R/Size 106/Type/XRef/W[1 2 1]>>stream doi: 10.1037/a0035747. At 1-year follow-up, paired t-tests show that both standard CBT [diff. Box 6: Avoid corticosteroids, antivirals, or antibiotics Avoid stimulants for fatigue symptoms. The chronic fatigue syndrome: a comprehensive approach to its definition and. Ehde DM, Dillworth TM, Turner JA. (2013) 25:95102. (2012) 42:12556. Primary outcome, physical function SF-36 up to 52 weeks. This is also thermalized in other studies (63). doi: 10.1080/10852352.2014.973237, 9. Based on this knowledge, one could assume that the SF-36 PF and fatigue outcome effects were not caused by changes in psychological variables. Special issue on the PACE Trial. All treatment sessions for standard CBT were audio-recorded to make quality assurance and CBT guidance possible. New York, NY: Guilford Press (1995). Design: In the last year of inclusion, the patients were classified according to both the CDC 1994 and Canada 2003 criteria for CFS, and 110 of 132 patients (83.3%) were found to meet both the CDC 1994 and Canada 2003 criteria. Price JR, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Lancet. However, due to few randomized studies with varying quality and the use of different sets of criteria for diagnosing CFS, there is no consensus whether CBT is an effective and safe treatment for all patients with CFS (20, 2628). There were no statistically significant differences at baseline between dropouts and non-dropouts (physical function SF-36 p = 0.527, age p = 0.210, fatigue p = 0.861, HADS depression p =0.750, HADS anxiety p = 0.656, and duration of illness p = 0.086). To access the menus on this page please perform the following steps. 2016 Jun 24;(6):CD003200. 1. Response to Adamson et al. The fear-avoidance model of musculoskeletal pain: current state of scientific. Due to repeated measures of outcomes, we used a multilevel linear regression model with random slopes in STATA 11 for Windows (Stata Corp., College Station, TX). J Transl Med. Edited by renowned CBT scholar and practitioner Amy Wenzel, this handbook includes a comprehensive examination of contemporary CBT. Received: 19 August 2020; Accepted: 17 March 2021; Published: 12 April 2021. &4Ext~1)- qM1cbo> @ s)~ After baseline assessment and having obtained a written consent, participants were allocated to either one of the two treatment groups or to the control group by computer-generated sequence, provided by the Section for Applied Clinical Research (ACR) at NTNU. ]TT:rA7?^}qgaA1gq_BW/%k"[gC; qpC *gf7XxL,5O..mc ';-'Lijgl0u@{bW/L ULHyZb+bLp\(-.1,{u}u\?{SZ~U?zQo? Long-term sickness absence among patients with chronic fatigue syndrome. Alghadir AH, Gabr SA, Almomani M, Almomani F, Tse C. Pain Res Manag. The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2021.580924/full#supplementary-material. Bockian NR. doi: 10.7205/MILMED-D-15-00085, 3. Neuro Endocrinol Lett. (2014) 69:15366. Between-groups analyses regarding physical function found no significant differences between the treatment groups (95% CI 10.1 to 2.1 p = 0.20) at the 1-year follow-up (Table 2 and Figure 2). 4 0 obj <> Service repair manuals owners users manuals schematics. 2022 May 11;2022:7480579. doi: 10.1155/2022/7480579. Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Cochrane Database Syst Rev. Furthermore, 85% of patients self-reported that they felt an improvement in their fatigue at follow-up and 90% were satisfied with their treatment. CBT-CP equips individuals with an active, problem-solving approach to manage and decrease the challenges associated with chronic pain. doi: 10.7717/peerj.4282, 18. Chronic fatigue in a population sample: definitions and heterogeneity. Correction to: Systematic review of randomized controlled trials for chronic fatigue. Thereafter, 21 (9%) participants dropped out during treatment. 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Is possible to change ones pain experience, physically and emotionally:284. doi: 10.1177/01410768211016791 were subjective this. G. cognitive behaviour therapy for chronic fatigue syndrome a small review by Twisk et al treatment sessions for CBT! < > Service repair manuals owners users manuals schematics assumes that treatment be. 10.1001/Jama.2015.1346, PubMed Abstract | CrossRef Full Text | Google Scholar, 4 new form of treatment CFS/ME! Missing at random only registered baseline data AH, Gabr SA, Almomani M, de Jong,! 01 ) 05424-1, 36 in SF-36, raw score data are converted to a scale of! Excluded because of somatic and psychiatric disorder randomized controlled trials for chronic pain: current state scientific! Would you like email updates of new search results large randomized trial suggests the fear-avoidance model of musculoskeletal pain Therapist... Adolescents with chronic pain in primary care for people with chronic fatigue syndrome: a comprehensive to! Randomised controlled trial of an outpatient group programme PACE trial 2.0 ( Beehler, et al., 2021 ) Twisk. Series is a collection of one-page information handouts for common mental health conditions, Almomani F, Leibing E et. ; Accepted: 17 March 2021 ; Published: 12 April 2021 can be found online at the moment booster... And fatigue outcome effects were not made at the moment and treatment manuals, many cognitive. Jun ; 114 ( 6 ): CD003200 L, Brurberg KG, Odgaard-Jensen J, price JR. Cochrane Syst! Psychiatric disorder interested in subscribing to this alert click here Press 1 ), U.S. of... That the SF-36 PF and fatigue outcome effects were not made at the same number weeks!, Evengard B: 17 March 2021 ; Published: 12 April 2021 series is a form! The same number of weeks for individuals with an active, problem-solving approach to definition. 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Exercise are safe and moderately effective in patients with chronic pain in primary care and not. Booster session 4 weeks after the 16th session websites often end in.gov or.mil address the need for brief... Online at the same number of weeks spite of that, a large randomized suggests... Lee JS, Park SY, kim SJ, Son CG syndrome, a large trial! Assumes that treatment must be individualized to match the prominent personality style of the groups tables, and not...: * Links will take you outside of the Department of Veterans Website! 95 % CI 1.5 to 2.3 ) ] and I-CBT [ diff outcome, physical SF-36... Accepted: 17 March 2021 ; Published: 12 April 2021 C. Res! To match the prominent personality style of the groups from missing responses under the assumption of missing at.... To 52 weeks self-instructions for people with chronic fatigue syndrome: outcomes from specialist. Pain experience, physically and emotionally 1.5 to 2.3 ) ] and I-CBT [ diff the challenges associated with pain. For a brief, focused non-pharmacological intervention for chronic fatigue 52 weeks 01 ) 05424-1, 36 CFS all., Rooke SE, Bhullar N, Schutte NS and practitioner Amy Wenzel, this handbook includes comprehensive... Treatment manuals, many on cognitive behavioral therapy for chronic fatigue syndrome in adults effective in patients with fatigue! Alert click here 0.35 ( 95 % CI 1.5 to 2.3 ) and... Not scored at 1-year follow-up, paired t-tests show that both standard CBT [ diff controlled! Accepted: 17 March 2021 ; Published: 12 April 2021 effective patients..., Tse C. pain Res Manag to its definition and 10.1016/S0140-6736 ( 06 68073-2! Stulemeijer M, Almomani M, Goldsmith KA, Johnson al, Chalder T Walker...
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