Open AccessPain in Patients with Chronic Fatigue Syndrome: Time for Specific Pain Treatment?
Author(s) -
Jo Nijs
Publication year - 2012
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2012/15/e677
Subject(s) - medicine , chronic fatigue syndrome , chronic pain , pain catastrophizing , hyperalgesia , fibromyalgia , central sensitization , dysfunctional family , depression (economics) , physical therapy , diffuse noxious inhibitory control , physical medicine and rehabilitation , noxious stimulus , nociception , psychiatry , receptor , economics , macroeconomics
Background: Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) havedebilitating 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 sameunderlying mechanisms as other CFS symptoms? Second, it is examined whether effectivetreatments 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 unlikelyto account for pain from CFS. Pain seems to be one out of many symptoms related to centralsensitization from CFS. This idea is supported by the findings of generalized hyperalgesia (includingwidespread increased responsiveness to painful stimuli) and dysfunctional endogenous analgesiain response to noxious thermal stimuli. Pain catastrophizing and depression partly account forpain from CFS. Pain increases during exercise is probably due to the lack of endogenous analgesiaand activation of several genes in response to exercise in CFS. There is currently no evidence insupport for the efficacy of complementary medicine in the treatment of pain from CFS. Intensiveeducation 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 behavioraltherapy appears to be effective for pain from CFS as well.Limitations: The role of the deficient hypothalamus-pituitary-adrenal axis in relation to painfrom CFS, as well as the interactions with immune (dys)functioning require further study.Conclusion: Recent research has increased our understanding of pain from CFS, includingits treatment. It is advocated to optimize current CFS treatment protocols by targeting theunderlying mechanism for those patients having severe pain.Key words: Chronic pain, chronic fatigue syndrome, fibromyalgia, central sensitization,catastrophizing, exercise, cognitive behavioral therapy.