Bloot, Lotte, Heins, Marianne J, Donders, Rogier et al. · The Clinical journal of pain · 2015 · DOI
This study looked at how cognitive-behavioral therapy (CBT)—a talk therapy that helps change thoughts and behaviors—reduces pain in ME/CFS patients. Researchers followed 142 patients over the course of their treatment and found that pain and fatigue tend to improve together. The improvement in pain appeared to be partly explained by patients doing more physical activity and thinking less about their symptoms, though other factors also played a role.
Understanding how and why pain improves during CBT is crucial for ME/CFS patients considering this treatment and for clinicians tailoring interventions. This study reveals that pain improvement is not simply a consequence of fatigue reduction but involves multiple simultaneous processes, which could inform more targeted and effective pain management strategies.
This study does not establish causality in the direction of change between pain and fatigue—they appear to improve together rather than one causing the other. The study also does not identify all factors responsible for pain reduction; the explained variance (4–14%) indicates that many additional mechanisms remain unknown. These findings apply only to CBT and may not generalize to other ME/CFS treatments.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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