Article

Chronic musculoskeletal pain in chronic fatigue syndrome: Recent developments and therapeutic implications

Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Bruxelles, Brussels Capital, Belgium
Manual Therapy (Impact Factor: 1.71). 09/2006; 11(3):187-91. DOI: 10.1016/j.math.2006.03.008
Source: PubMed

ABSTRACT

Patients with chronic fatigue syndrome (CFS) experience chronic musculoskeletal pain which is even more debilitating than fatigue. Scientific research data gathered around the world enables clinicians to understand, at least in part, chronic musculoskeletal pain in CFS patients. Generalized joint hypermobility and benign joint hypermobility syndrome appear to be highly prevalent among CFS sufferers, but they do not seem to be of any clinical importance. On the other hand, pain catastrophizing accounts for a substantial portion of musculoskeletal pain and is a predictor of exercise performance in CFS patients. The evidence concerning pain catastrophizing is supportive of the indirect evidence of a dysfunctional pain processing system in CFS patients with musculoskeletal pain. CFS sufferers respond to incremental exercise with a lengthened and accentuated oxidative stress response, explaining muscle pain, postexertional malaise, and the decrease in pain threshold following graded exercise in CFS patients. Applying the scientific evidence to the manual physiotherapy profession, pacing self-management techniques and pain neurophysiology education are indicated for the treatment of musculoskeletal pain in CFS patients. Studies examining the effectiveness of these strategies for CFS patients are warranted.

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    • "This anticipates etiological heterogeneity for CFS and the possible role for JHM in characterizing a specific subtype of CFS. This point still needs further investigations [Nijs et al., 2006b]. "
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    • "In these patients, local musculoskeletal problems are more than epiphenomenona and serve as a continuous source of afferent painful barrage (Nijs et al., 2006). Appropriate manual physiotherapy is unlikely to cure the chronic widespread pain, but can still resolve the localised musculoskeletal pain problem and thus decrease afferent barrage (Nijs et al., 2006). However , clinicians should be aware of the consequences of central sensitisation (i.e. a marked reduced sensory threshold) and adapt their hands-on techniques and exercise programs accordingly. "

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