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Pain in patients with chronic fatigue syndrome: time for specific pain treatment?

(2012) PAIN PHYSICIAN. 15(5). p.E677-E686
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Abstract
Background: Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers. Objectives: To examine whether pain is a unique feature of CFS, or does it share the same underlying mechanisms as other CFS symptoms? Second, it is examined whether effective treatments for pain from CFS are currently available. Study Design: Narrative review covering the scientific literature up through December 2011. Setting: Several universities. Results: From the available literature, it is concluded that musculoskeletal factors are unlikely to account for pain from CFS. Pain seems to be one out of many symptoms related to central sensitization from CFS. This idea is supported by the findings of generalized hyperalgesia (including widespread increased responsiveness to painful stimuli) and dysfunctional endogenous analgesia in response to noxious thermal stimuli. Pain catastrophizing and depression partly account for pain from CFS. Pain increases during exercise is probably due to the lack of endogenous analgesia and activation of several genes in response to exercise in CFS. There is currently no evidence in support for the efficacy of complementary medicine in the treatment of pain from CFS. Intensive education about the biology of pain from CFS (within the framework of central sensitization) has positive short-term effects for patients with CFS, and fatigue-targeting cognitive behavioral therapy appears to be effective for pain from CFS as well. Limitations: The role of the deficient hypothalamus-pituitary-adrenal axis in relation to pain from CFS, as well as the interactions with immune (dys) functioning require further study. Conclusion: Recent research has increased our understanding of pain from CFS, including its treatment. It is advocated to optimize current CFS treatment protocols by targeting the underlying mechanism for those patients having severe pain.
Keywords
CHRONIC MUSCULOSKELETAL PAIN, COGNITIVE-BEHAVIORAL THERAPY, LOW-BACK-PAIN, WHIPLASH-ASSOCIATED DISORDERS, RANDOMIZED CONTROLLED-TRIAL, NITRIC-OXIDE, CENTRAL SENSITIZATION, MYALGIC ENCEPHALOMYELITIS, CEREBROSPINAL-FLUID, SPATIAL SUMMATION, Chronic pain, chronic fatigue syndrome, fibromyalgia, central sensitization, catastrophizing, exercise, cognitive behavioral therapy

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Citation

Please use this url to cite or link to this publication:

Chicago
Nijs, Jo, Geert Crombez, Mira Meeus, Hans Knoop, Stefaan Van Damme, Deborah Van Cauwenbergh, and Gijs Bleijenberg. 2012. “Pain in Patients with Chronic Fatigue Syndrome: Time for Specific Pain Treatment?” Pain Physician 15 (5): E677–E686.
APA
Nijs, Jo, Crombez, G., Meeus, M., Knoop, H., Van Damme, S., Van Cauwenbergh, D., & Bleijenberg, G. (2012). Pain in patients with chronic fatigue syndrome: time for specific pain treatment? PAIN PHYSICIAN, 15(5), E677–E686.
Vancouver
1.
Nijs J, Crombez G, Meeus M, Knoop H, Van Damme S, Van Cauwenbergh D, et al. Pain in patients with chronic fatigue syndrome: time for specific pain treatment? PAIN PHYSICIAN. 2012;15(5):E677–E686.
MLA
Nijs, Jo, Geert Crombez, Mira Meeus, et al. “Pain in Patients with Chronic Fatigue Syndrome: Time for Specific Pain Treatment?” PAIN PHYSICIAN 15.5 (2012): E677–E686. Print.
@article{2958667,
  abstract     = {Background: Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers. Objectives: To examine whether pain is a unique feature of CFS, or does it share the same underlying mechanisms as other CFS symptoms? Second, it is examined whether effective treatments for pain from CFS are currently available. Study Design: Narrative review covering the scientific literature up through December 2011. Setting: Several universities. Results: From the available literature, it is concluded that musculoskeletal factors are unlikely to account for pain from CFS. Pain seems to be one out of many symptoms related to central sensitization from CFS. This idea is supported by the findings of generalized hyperalgesia (including widespread increased responsiveness to painful stimuli) and dysfunctional endogenous analgesia in response to noxious thermal stimuli. Pain catastrophizing and depression partly account for pain from CFS. Pain increases during exercise is probably due to the lack of endogenous analgesia and activation of several genes in response to exercise in CFS. There is currently no evidence in support for the efficacy of complementary medicine in the treatment of pain from CFS. Intensive education about the biology of pain from CFS (within the framework of central sensitization) has positive short-term effects for patients with CFS, and fatigue-targeting cognitive behavioral therapy appears to be effective for pain from CFS as well. Limitations: The role of the deficient hypothalamus-pituitary-adrenal axis in relation to pain from CFS, as well as the interactions with immune (dys) functioning require further study. Conclusion: Recent research has increased our understanding of pain from CFS, including its treatment. It is advocated to optimize current CFS treatment protocols by targeting the underlying mechanism for those patients having severe pain.},
  author       = {Nijs, Jo and Crombez, Geert and Meeus, Mira and Knoop, Hans and Van Damme, Stefaan and Van Cauwenbergh, Deborah and Bleijenberg, Gijs},
  issn         = {1533-3159},
  journal      = {PAIN PHYSICIAN},
  keywords     = {CHRONIC MUSCULOSKELETAL PAIN,COGNITIVE-BEHAVIORAL THERAPY,LOW-BACK-PAIN,WHIPLASH-ASSOCIATED DISORDERS,RANDOMIZED CONTROLLED-TRIAL,NITRIC-OXIDE,CENTRAL SENSITIZATION,MYALGIC ENCEPHALOMYELITIS,CEREBROSPINAL-FLUID,SPATIAL SUMMATION,Chronic pain,chronic fatigue syndrome,fibromyalgia,central sensitization,catastrophizing,exercise,cognitive behavioral therapy},
  language     = {eng},
  number       = {5},
  pages        = {E677--E686},
  title        = {Pain in patients with chronic fatigue syndrome: time for specific pain treatment?},
  volume       = {15},
  year         = {2012},
}

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