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Catastrophizing and depression are the main predictors for pain in patients with CFS



The 2024 Global Year will examine what is known about sex and gender differences in pain perception and modulation and address sex-and gender-related disparities in both the research and treatment of pain.

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It is known that chronic fatigue syndrome (CFS) patients often present unhelpful pain beliefs / behaviors, such as catastrophic thinking, depressive thoughts, passive coping strategies and fear of movement or kinesiophobia.  Several of these beliefs and personality traits could potentially enhance pain perception, a process known as cognitive emotional sensitization.

Therefore we studied the role of several psychosocial determinants of chronic pain in CFS patients.[1] Pain catastrophizing, depression, kinesiophobia and several passive coping styles were related to pain, but catastrophizing and depression were the main predictors for pain measured at the same time and measured 6 to 12 months later in patients with CFS with chronic widespread musculoskeletal pain. Depression and catastrophizing were able to predict 23% of the pain variance 6 to 12 months later.

Since these factors may be at the basis of chronic pain and act as important therapy barriers in CFS it is important to consider these psychosocial factors in the approach of CFS patients experiencing chronic widespread pain. The therapeutic approach of these patients is indeed a real challenge, because there is not a clear source of nociception and complaints are widespread and general. Furthermore, CFS patients often present with low tolerance or fear to certain physical therapy modalities (e.g. exercise, painful manual techniques, etc.) and those typical unhelpful pain cognitions / behaviors. Therefore, besides or before addressing the physical components, the treatment approach of these patients should account for these cognitive and emotional aspects.

The latter may in fact be the first point of interest in the therapeutic approach, since these factors are related to the pain and may be important therapy barriers. A possible tool to influence these psychological factors and in consequence eventually pain is providing pain education, which has already been shown to be efficacious in reducing pain catastrophizing in CFS patients.[2]

About Mira Meeus

Dr Mira MeeusMira Meeus obtained her PhD degree in Rehabilitation Sciences and Physiotherapy in 2008 at the Vrije Universiteit Brussel (Belgium) on central sensitization in chronic fatigue syndrome. Presently, she is assistant professor at Ghent University and at the Artesis University College Antwerp (Belgium). Her main research topics of interest are chronic pain, central sensitization, exercise pathophysiology and rehabilitation in chronic pain populations like those suffering from chronic fatigue syndrome, fibromyalgia, and chronic whiplash associated disorders. She is (co-)author of +/- 40 publications in international peer-reviewed journals and is 2012 awardee of the IASP early research career grant.


[1] Meeus M, Nijs J, Van Mol E, Truijen S, & De Meirleir K (2012). Role of psychological aspects in both chronic pain and in daily functioning in chronic fatigue syndrome: a prospective longitudinal study. Clinical rheumatology, 31 (6), 921-9 PMID: 22349876

[2] Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, & Truijen S (2010). Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial. Arch Phys Med Rehab, 91 (8), 1153-9 PMID: 20684894

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