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Jo Nijs
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== Controversy == === Pain neurophysiology education === Before starting exercise therapy in CS patients, Nijs promotes the use of ‘pain neurophysiology education’, in which the patient is told that pain doesn’t always involve nociceptive input and vice versa. Nijs emphasized that this method might convince patients wary of a psychological approach:<blockquote>"The innovative aspect of pain physiology education is the use of physiology (i.e., the mechanism of central sensitization) to change perceptions and cognitions. This makes it appropriate even for CFS cases reluctant to the biopsychosocial model."<ref name="specific2012" /></blockquote>Tom Kindlon questioned ‘neurophysiology education’ since it advises to ignore chronic pain while little is known about the mechanisms and etiology of pain in ME/CFS. Kindlon also criticized one of the primary justifications for the pain management program; that it might increase therapy adherence - that is adherence to graded exercise therapy:<blockquote>“Until a particular exercise regimen has been shown to be safe in CFS, in the interim it seems questionable, and indeed possibly unethical, to have adherence to such an intervention as the goal of any educational program.”<ref>Kindlon T. Educational programs for chronic fatigue syndrome need to take cognizance of the condition's abnormal response to exercise. Arch Phys Med Rehabil. 2011 Jun;92(6):1015; author reply 1015-6.</ref></blockquote> ===Is it unethical to question GET? === In 2013, Nijs' position towards GET was questioned by Twisk & Arnoldus. Nijs reposted that it was 'unethical' to downplay the effectiveness of GET for ME/CFS patients:<blockquote>"[…] at the group level, there is no doubt that graded exercise therapy and cognitive behavioural therapy are effective treatments for ME/CFS. Saying the reverse might prevent clinicians from applying these treatments to their ME/CFS patients. In the absence of alternative treatment options (recall that besides graded exercise therapy and cognitive behavioural therapy, no other treatment has proven to be beneficial to ME/CFS patients), this would be unethical."<ref name="Kooning2012" /></blockquote>Nijs also suggested that opposition to GET might be fuelled by a conflict of interest of patient advocates: <blockquote>"At the same time, one can imagine that refuting the evidence favouring conservative interventions for ME/CFS might be inspired by a conflict of interest (e.g. personal interest in biopharmaceutical companies or as a ME/CFS patient running for a disability payment)."<ref name="Kooning2012" /></blockquote> ===Are ME/CFS and fibromyalgia the same? === The publications of Nijs and collagues often lump ME/CFS and fibromyalgia together as if they are one disorder. For example in their 2013 book on the treatment of persistent fatigue directed at clinicians (written in Dutch),<ref name="Kos2005">{{Cite book | last = Kos | first = D | last2 = Nijs | first2 = J | last3 = Meeus | first3 = M | last4 = Salhi | first4 = B. | url = https://books.google.be/books?id=nap0ngEACAAJ&dq=Chronische+vermoeidheid:+een+praktische+handleiding+voor+de+revalidatie+van+kanker,+MS,&hl=nl | title = Chronische vermoeidheid: een praktische handleiding voor de revalidatie van kanker, MS, fibromyalgie en CVS|publisher=Acco|language=nl| date = 2012 |trans-title=|chapter=|location=Leuven|isbn=|edition=|volume=|chapter-url=|pages=|editor-last = |editor-first = |editor1-link=|editor-last2 = |editor-first2 = |editor2-link=|veditors=|others=|quote=}}</ref> no distinction is made between ME/CFS and fibromyalgia. The rationale behind this is that both disorders have similar symptoms and are (supposedly) characterized by central sensitization. Most researchers however emphasize the importance of dealing with ME/CFS and fibromyalgia separately, since there might be biological differences between the two.<ref name="Abbi2013">Abbi B and Natelson BH. Is chronic fatigue syndrome the same illness as fibromyalgia: evaluating the 'single syndrome' hypothesis. QJM. 2013 Jan;106(1):3-9.</ref>
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