Miller, Vanessa Eve, Barnhill, Jessica, Greco, Carol M et al. · European journal of pain (London, England) · 2025 · DOI
This study looked at people with chronic low back pain to see how often they also have other long-term pain conditions like fibromyalgia, irritable bowel syndrome, and ME/CFS. Researchers found that 45% of people with back pain also had at least one other chronic pain condition, and these people reported more pain, fatigue, anxiety, and depression than those with back pain alone. The study suggests that chronic pain conditions often occur together and may share similar underlying causes.
This study provides epidemiological evidence that ME/CFS frequently co-occurs with other chronic pain conditions (19% prevalence in this cLBP cohort), supporting the hypothesis that COPCs share common pathophysiological mechanisms. Understanding the high burden of symptom overlap—particularly fatigue, anxiety, and depression—can improve clinical recognition and guide treatment strategies for ME/CFS patients who often present with multiple concurrent conditions.
This study does not establish causal relationships between overlapping pain conditions or prove a shared biological mechanism. The cross-sectional prevalence data cannot determine whether one condition causes another or whether they develop from the same underlying process. Additionally, the sample was enrolled in a mindfulness-based stress reduction trial, which may not be representative of all people with cLBP or ME/CFS.
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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