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:2Date:2 July 2014
Reviewer: Jason Craggs
Reviewer's report:
Journal: BMS Gastroenterology
Ms. No.: 2117699482101819_R1
Title: The severity of irritable bowel syndrome or the presence of fibromyalgia
influencing the perception of visceral and somatic stimuli
Reviewer: 3
This is a revised submission regarding a study that sought to examine visceral
and somatic perception among individuals with mild IBS and severe IBS (with
and without fibromyalgia). As before, I applaud the authors for undertaking this
ambitious work, the results of may help shape how we come to understand pain
perception in clinical populations.
However, at this time, I cannot recommend the revised manuscript, in its present
form, as I do not think the authors adequately addressed the concerns raised by
this and the other reviewers. Thus, I maintain that the authors should make a
number of changes that will justify the need for this study and improve the overall
readability of the manuscript.
Compulsory revisions:
For example, in my previous review I stated: "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." - A point the authors concede in their response
letter, and mention on page 17, line 20. Despite this acknowledgment the authors
did not provide a stronger justification for doing this study. Thus, I have a difficult
time seeing what new information that results from this study provide to the
literature.
Below are a few other examples of issues I strongly encouraged authors to
address.
Previously, I encourage the authors to provide information regarding how
subjects provided their responses during the experiment. In the revised
submission, the authors did not amend the text nor did they provide the
requested information. To clarify, did the participants provide verbal ratings,
electronic VAS ratings, use some sort of rating mechanism etc.?
The revised manuscript did not discuss the potential consequence of their
discomfort threshold data having a ceiling effect.
The authors did not address the issue of potential outliers in their data, nor did
they provide any descriptive statistics to characterize their sample. Furthermore,
the relationships to the limits used in their study and a "normal distribution" that
has nothing to do with their data, is unclear.
Finally, regarding the experimental protocol, unclear are the circumstances
where the stimulus would result in unexpected pain. Consequently, the
experimenter protocol seems to measure the expectation of pain rather than pain
intensity.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.