Review for 10.1186/1471-230X-14-182 (2014)

Reviewer's report
Title:The severity of irritable bowel syndrome or the presence of fibromyalgia
influencing the perception of visceral and somatic stimuli
Version:1Date:7 May 2014
Reviewer: Jason Craggs
Reviewer's report:
Journal: BMS Gastroenterology
Ms. No.: 2117699482101819
Title: The severity of irritable bowel syndrome or the presence of fibromyalgia
influencing the perception of visceral and somatic stimuli
This study sought to examine visceral and somatic perception among individuals
with mild IBS and severe IBS (with and without fibromyalgia). In general, I
applaud the authors for undertaking this ambitious work, the results of which will
no doubt shape how we come to understand pain perception in clinical
populations.
However, at this time, I cannot recommend the manuscript, in its present form,
for publication until the authors make a number of compulsory changes outlined
below. These clarifications will aid readers in their ability to follow the results in a
more systematic manner and have confidence in the points being made by the
authors at the end of the manuscript.
Introduction
The authors do a fair job associating IBS with fibromyalgia. However, on page 5
of the introduction, they seem to imply that IBS and fibromyalgia may be on
opposite ends of the same spectrum. For this reason, they chose the groups
included in the study. If this was the premise they intended, the strength of their
argument needs to be bolstered substantially.
A common clinical finding is that illness severity increases with the number of
concomitant disorders. From this perspective alone, the results of this study
seem almost a foregone conclusion. The authors are encouraged to make a
stronger justification for conducting the study in the subsequent revision.
Methods
On the whole, the methods and materials section is somewhat confusing. For
example, on page 8, the authors discuss the use of an "sham stimulus" without
elaboration. Without further information, the reader is unable to follow the
experimental protocol conceptually and may have difficulty accepting the results
and points made in the discussion section.
The authors are also encouraged to provide information related to how subjects
provided their responses during the experiment.
The authors define the discomfort threshold as the first stimulus with the score #
5. However, the maximum score could only be 5 1/2 as the experiment was
terminated if participants rated a 6. If this is accurate, the authors are
encouraged to discuss the possibility and consequences of having a ceiling effect
in their data.
Results
The authors state that the upper limit of the somatic perception cumulative score
was established based on the reporting of one patient. Based on the text, this
one patient may well be an outlier, and not representative of the rest of the
sample. The authors are encouraged to examine this possibility and discuss any
relevant findings in a subsequent revision.
Likewise, the upper limit of 12 mmHg was established based on the scores of
just two patients. Were these participants outliers, or at the upper end of the
normal distribution?
Discussion
Without the aforementioned information, readers will have a difficult time
adequately accepting the points made in the discussion section based on the
results of the current study. Furthermore, the authors are encouraged to
contextualize their results more thoroughly in the discussion section; for its
current state seems more similar to an introduction than anything else.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests