Pain and pressure pain thresholds in adolescents with chronic fatigue syndrome and healthy controls

[Dolphin]

Free full text- http://bmjopen.bmj.com/content/4/10/e005920.full

BMJ Open 2014;4:e005920 doi:10.1136/bmjopen-2014-005920

Paediatrics

Pain and pressure pain thresholds in adolescents with chronic fatigue syndrome and healthy controls: a cross-sectional study

Anette Winger1, Gunnvald Kvarstein2, Vegard Bruun Wyller3,4,5, Dag Sulheim4,6, Even Fagermoen3, Milada Cvancarova Småstuen1, Sølvi Helseth1


+ Author Affiliations


1Faculty of Health Sciences, Institute of Nursing, Oslo and Akershus University College of Applied Sciences, Oslo, Norway 2Department of Clinical Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway 3Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway 4Department of Pediatrics, Oslo University Hospital, Norway 5Department of Pediatrics, Akershus University Hospital, Norway 6Department of Pediatrics, Lillehammer County Hospital, Lillehammer, Norway.


Correspondence to Anette Winger; anette.winger@hioa.no


Received 17 June 2014

Revised 9 August 2014

Accepted 27 August 2014

Published 6 October 2014


Abstract


Objectives: Although pain is a significant symptom in chronic fatigue syndrome (CFS), pain is poorly understood in adolescents with CFS.

The aim of this study was to explore pain distribution and prevalence, pain intensity and its functional interference in everyday life, as well as pressure pain thresholds (PPT) in adolescents with CFS and compare this with a control group of healthy adolescents (HC).


Methods:

This is a case–control, cross-sectional study on pain including 120 adolescents with CFS and 39 HCs, aged 12–18 years.

We measured pain frequency, pain severity and pain interference using self-reporting questionnaires.

PPT was measured using pressure algometry.

Data were collected from March 2010 until October 2012 as part of the Norwegian Study of Chronic Fatigue Syndrome in

Adolescents: Pathophysiology and Intervention Trial.


Results:

Adolescents with CFS had significantly lower PPTs compared with HCs (p<0.001).

The Pain Severity Score and the Pain Interference Score were significantly higher in adolescents with CFS compared with HCs (p<0.001).

Almost all adolescents with CFS experienced headache, abdominal pain and/or pain in muscles and joints. Moreover, in all sites, the pain intensity levels were significantly higher than in HCs (p<0.001).


Conclusions:

We found a higher prevalence of severe pain among adolescents with CFS and lowered pain thresholds compared with HCs.

The mechanisms, however, are still obscure. Large longitudinal population surveys are warranted measuring pain thresholds prior to the onset of CFS.


Trial registration number Clinical Trials, NCT01040429; The Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial (NorCAPITAL) http://www.clinicaltrials.gov.

 

[Dolphin]

There was a bit of psychobabble speculation in the discussion, and little discussion of physical causes except "central sensitisation" which can lead to patient blaming I think:

Researchers have suggested that patients with CFS are genetically more prone to develop the disease, 20 in line with epidemiological data on chronic pain. 42 The factors and processes for pain among patients with CFS remain unclear, but in other populations, pain beliefs, emotions, understanding of pain and psychosocial factors have been found to influence the perception of pain. 43 In patients with fibromyalgia, Turk 43 showed that fear of movement maintains the pain experience and increases the disability. The model on pain-related fear and avoidance suggests this as essential for perpetuation of pain, 44 and among adults with CFS, Nijset al 45 demonstrate a clear association between pain catastrophising, pain severity and activity limitation/participation. There is no obvious reason to believe that this is not the case for adolescents with CFS. Negative thoughts may also develop when patients do not understand the aetiology of pain. 36 A qualitative study suggests that multiple perspectives, including individual differences, developmental and relational focus, should be taken into account when treating and studying young persons with CFS. 46 Cognitive behaviour therapy for CFS has shown to be effective in improving fatigue and pain in adults and adolescents. 4 A multidimensional perspective of CFS, opposing the dichotomy between bodily and mental processes and acknowledging the impact of cognitive processes on physiological responses, is supported by previous studies 47 48 and is in line with the sustained arousal theory. 20

 

[Dolphin]

There may be somebody somewhere e.g. from the Netherlands, who might be interested in the review history http://bmjopen.bmj.com/content/4/10/e005920.reviewer-comments.pdf as van de Putte recommends against publication (apart from the criteria point, I don't think I'd agree).

 

[user9876]

There may be somebody somewhere e.g. from the Netherlands, who might be interested in the review history http://bmjopen.bmj.com/content/4/10/e005920.reviewer-comments.pdf as van de Putte recommends against publication (apart from the criteria point, I don't think I'd agree).

The initial bit of the review is surprising in that it says the study is not new so shouldn't be published. What happened to the desire to have replicated studies.