title: Pain in patients with chronic fatigue syndrome: time for specific pain treatment?
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Narrative review covering the scientific literature up through December 2011.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Chronic Pain and Chronic Fatigue Research Group, Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Belgium. drlm@thepainmd.com
authors.forename: Jo
authors.initials: J
authors.lastname: Nijs
authors.forename: Geert
authors.initials: G
authors.lastname: Crombez
authors.forename: Mira
authors.initials: M
authors.lastname: Meeus
authors.forename: Hans
authors.initials: H
authors.lastname: Knoop
authors.forename: Stefaan Van
authors.initials: SV
authors.lastname: Damme
authors.forename: Vandeborah
authors.initials: V
authors.lastname: Cauwenbergh
authors.forename: Gijs
authors.initials: G
authors.lastname: Bleijenberg
mesh_terms: D016208:Databases, Factual / Q000706:statistics & numerical data; D015673:Fatigue Syndrome, Chronic / Q000150:complications* / Q000628:therapy*; D006801:Humans; D015337:Multicenter Studies as Topic; D010146:Pain / Q000150:complications* / Q000523:psychology; D010147:Pain Measurement