Clinical Rheumatology

, Volume 29, Issue 4, pp 393–398 | Cite as

Evidence for generalized hyperalgesia in chronic fatigue syndrome: a case control study

  • Mira Meeus
  • Jo Nijs
  • Sven Huybrechts
  • Steven Truijen
Original Article

Abstract

Several studies provided evidence for generalized hyperalgesia in fibromyalgia or whiplash-associated disorders. In chronic fatigue syndrome, however, pain is a frequently reported complaint, but up to now, evidence for generalized hyperalgesia is lacking. The aim of this study is to examine whether the pressure pain thresholds (PPTs) at both symptomatic and asymptomatic sites differ in chronic fatigue syndrome (CFS) patients with chronic pain, compared to healthy controls. Therefore, 30 CFS patients with chronic pain and 30 age- and gender-matched healthy controls indicated on a Margolis Pain Diagram where they felt pain lasting longer than 24 h in the past 4 weeks. After completing a test battery of questionnaires evaluating pain cognitions, functional status and symptomatology, a blinded researcher assessed PPTs bilaterally at seven non-specific sites on both trunk and extremities. PPTs were compared for the two complete groups. In addition, PPTs of patients and controls who did not report pain in a respective zone were compared. PPTs of the patients were significantly lower (p < 0.001) compared to those of the control group, also when pain-free samples per zone were compared (p < 0.001). The mean PPT was 3.30 kg/cm2 in all CFS patients and 8.09 kg/cm2 in the controls. No confounding factors responsible for the observed differences, as, e.g., catastrophizing and depression, could be revealed. These findings provide evidence for the existence of hyperalgesia even in asymptomatic areas (generalized secondary hyperalgesia). The generalized hyperalgesia may represent the involvement of a sensitized central nervous system.

Keywords

Central sensitization Hyperalgesia Hypersensitivity Pain drawing Pressure pain thresholds 

References

  1. 1.
    CFS/ME Working Group, Report to the Chief Medical Officer of an independent working group, London: Department of Health, www.doh.gov.uk/cmo/cfsmereport/index.htm, London: Department of Health, www.doh.gov.uk/cmo/cfsmereport/index.htm, 2001.
  2. 2.
    Jason LA, Richman JA, Rademaker AW, Jordan KM, Plioplys AV, Taylor RR, McCready W, Huang CF, Plioplys S (1999) A community-based study of chronic fatigue syndrome. Arch Intern Med 159:2129–2137.CrossRefPubMedGoogle Scholar
  3. 3.
    Bradley LA, McKendree-Smith NL, Alarcon GS (2000) Pain complaints in patients with fibromyalgia versus chronic fatigue syndrome. Curr Rev Pain 4:148–157.PubMedGoogle Scholar
  4. 4.
    Staud R, Smitherman ML (2002) Peripheral and central sensitization in fibromyalgia: pathogenetic role. Curr Pain Headache Rep 6:259–266.CrossRefPubMedGoogle Scholar
  5. 5.
    Banic B, Petersen-Felix S, Andersen OK, Radanov BP, Villiger PM, Arendt-Nielsen L, Curatolo M (2004) Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain 107:7–15.CrossRefPubMedGoogle Scholar
  6. 6.
    Sterling M, Jull G, Vicenzino B, Kenardy J (2004) Characterization of acute whiplash-associated disorders. Spine 29:182–188.CrossRefPubMedGoogle Scholar
  7. 7.
    Coderre TJ, Katz J, Vaccarino AL, Melzack R (1993) Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 52:259–85.CrossRefPubMedGoogle Scholar
  8. 8.
    Meeus M, Nijs J (2007) Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clin Rheumatol 26:465–73.CrossRefPubMedGoogle Scholar
  9. 9.
    Koelbaek Johansen M, Graven-Nielsen T, Schou Olesen A, Arendt-Nielsen L (1999) Generalised muscular hyperalgesia in chronic whiplash syndrome. Pain 83:229–34.CrossRefPubMedGoogle Scholar
  10. 10.
    Giesbrecht RJ, Battie MC (2005) A comparison of pressure pain detection thresholds in people with chronic low back pain and volunteers without pain. Phys Ther 85:1085–92.PubMedGoogle Scholar
  11. 11.
    Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 121:953–9.PubMedGoogle Scholar
  12. 12.
    Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, et al. (1990) The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33:160–72.CrossRefPubMedGoogle Scholar
  13. 13.
    Margolis RB, Tait RC, Krause SJ (1986) A rating system for use with patient pain drawings. Pain 24:57–65.CrossRefPubMedGoogle Scholar
  14. 14.
    Whiteside A, Hansen S, Chaudhuri A (2004) Exercise lowers pain threshold in chronic fatigue syndrome. Pain 109:497–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Farasyn A, Meeusen R (2005) The influence of non-specific low back pain on pressure pain thresholds and disability. Eur J Pain 9:375–81.CrossRefPubMedGoogle Scholar
  16. 16.
    Farasyn A, Meeusen R (2003) Pressure pain thresholds in healthy subjects: influence of physicaal activity, history of lower back pain factors and the use of endermology as a placebo-like treatment. J Bodywork Mov Ther 7:53–61.CrossRefGoogle Scholar
  17. 17.
    Kosek E, Ekholm J, Hansson P (1999) Pressure pain thresholds in different tissues in one body region. The influence of skin sensitivity in pressure algometry. Scand J Rehabil Med 31:89–93CrossRefPubMedGoogle Scholar
  18. 18.
    Bishop SR, Edgley K, Fisher R, Sullivan MJL (1993) Screening for depression in chronic low back pain with the Beck Depression Inventory. Can J Rehab 7:143–148.Google Scholar
  19. 19.
    Van Damme S, Crombez G, Bijttebier P, Goubert L, Van Houdenhove B (2002) A confirmatory factor analysis of the Pain Catastrophizing Scale: invariant factor structure across clinical and non-clinical populations. Pain 96:319–24.CrossRefPubMedGoogle Scholar
  20. 20.
    Roelofs J, Peters ML, McCracken L, Vlaeyen JW (2003) The pain vigilance and awareness questionnaire (PVAQ): further psychometric evaluation in fibromyalgia and other chronic pain syndromes. Pain 101:299–306.CrossRefPubMedGoogle Scholar
  21. 21.
    Ware JE, Jr., Snow KK, Kosinki M, Gandek B (1993) SF-36 Health Survey manual and interpretation guide, The Health Institute, BostonGoogle Scholar
  22. 22.
    McHorney CA, Ware JE Jr., Raczek AE (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31:247–63.CrossRefPubMedGoogle Scholar
  23. 23.
    Nijs J, Thielemans A (2008) Kinesiophobia and symptomatology in chronic fatigue syndrome: a psychometric study of two questionnaires. Psychology and Psychotherapy: Theory, Research and Practice 81:273–283.Google Scholar
  24. 24.
    Meeus M, Nijs J, Van de Wauwer N, Toeback L, Trujen S (2008) Diffuse noxious inhibitory control is delayed in chronic fatigue syndrome: An experimental study. Pain 139:439–448.CrossRefPubMedGoogle Scholar
  25. 25.
    Zusman M (2002) Forebrain-mediated sensitization of central pain pathways: ‘non-specific’ pain and a new image for MT. Man Ther 7:80–8.CrossRefPubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  • Mira Meeus
    • 1
    • 2
  • Jo Nijs
    • 1
    • 2
  • Sven Huybrechts
    • 1
  • Steven Truijen
    • 1
  1. 1.Department of Health SciencesDivision of Musculoskeletal Physiotherapy, Artesis Hogeschool Antwerpen (AHA)MerksemBelgium
  2. 2.Department of Human PhysiologyFaculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel (VUB)BrusselsBelgium

Personalised recommendations