Chronic musculoskeletal pain in patients with the chronic fatigue syndrome: 
A systematic review.

Eur J Pain. 2006 Jul 12; [Epub ahead of print]

Mira Meeus {a, b, *] Jo Nijs [a, b] and Kenny De Meirleir [a, b]

Affiliations:
[a] Division of Musculoskeletal Physiotherapy, Higher Institute of 
Physiotherapy, Department of Health Care Sciences, Hogeschool Antwerpen 
(HA), Van Aertselaerstraat 31, 2170 Merksem, Belgium
[b] Department of Human Physiology, Faculty of Physical Education and 
Physiotherapy, Vrije Universiteit Brussel (VUB), Belgium
[*] Corresponding author. Tel.: +32 3 641 82 05. E-mail: <Mira.Meeus@vub.ac.be>

Received 19 February 2006;
revised 7 June 2006;
accepted 7 June 2006.
Available online 13 July 2006.

NLM Citation: PMID: 16843021


BACKGROUND: In addition to debilitating fatigue the majority of patients 
with chronic fatigue syndrome (CFS) experience chronic widespread pain.

AIMS: Conducting a systematic review to critically assess the existing 
knowledge on chronic pain in CFS. We focussed on the definition, the 
prevalence and incidence, the aetiology, the relevance and the therapy 
strategy for chronic musculoskeletal pain and post-exertional pain in CFS.

METHODS: To identify relevant articles, we searched eight medical search 
engines. The search terms "chronic fatigue syndrome" AND "pain", 
"nociception", "arthralgia" and "myalgia", were used to identify articles 
concerning pain in CFS. Included articles were reviewed by two blinded 
researchers.

RESULTS: Twenty-five articles and two abstracts were identified and 
selected for further appraisal. Only 11 search results focussed on 
musculoskeletal pain in CFS patients. Regarding the standardized review of 
the articles, a 96% agreement between the researchers was observed. There 
is no consensus in defining chronic widespread pain in CFS, and although 
there is little or no strong proof for the exact prevalence, chronic pain 
is strongly disabling in CFS. Aetiological theories are proposed (sleep 
abnormalities, tryptophan, parovirus-B, hormonal and brain abnormalities 
and central sensitisation) and a reduction of pain threshold after exercise 
has been shown. Furthermore depression seemed not related to pain in CFS 
and a staphylococcus toxoid vaccine caused no significant pain reduction.

CONCLUSIONS: The results from the systematic review highlight the clinical 
importance of chronic pain in CFS, but only few studies addressing the 
aetiology or treatment of chronic pain in CFS are currently available.

Keywords: Chronic fatigue syndrome (CFS); Musculoskeletal pain; 
Epidemiology; Aetiology; Treatment; Review