Pain in Patients with Chronic Fatigue Syndrome: Time for Specific Pain Treatment?
- Source: Pain Physician, Sep-Oct 2012
[Note: Studies indicate 94% of ‘chronic fatigue syndrome’ (ME/CFS) patients suffer with muscle pain, 84% joint pain, and 80% headache - and pain is a key factor in disability levels. The full text of this report summarizing current knowledge regarding the nature and importance of pain in ME/CFS is available free at http://www.painphysicianjournal.com/2012/september/2012;15;E677-E686.pdf.
• Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain.
• Yet pain from CFS is often ignored by clinicians and researchers.
• 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 [muscle/bone disorder or trauma] 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 [are] probably due to the lack of endogenous analgesia [body's natural pain modulation] 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.
• 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.
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.
Source: Pain Physician, Sep-Oct 2012; 15(5):E677-86. By Nijs J, Crombez G, Meeus M, Knoop H, Van Damme S, Van Cauwenbergh D, Bleijenberg G. Chronic Fatigue Research Group, Vrije Universiteit Brussel, Brussels; Artesis University College Antwerp; University Hospital Brussels; and Ghent University, Belgium; Radboud University Nijmegen Medical Centre, The Netherlands. [Email: Jo.Nijs@vub.ac.be]