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Chronic Fatigue Syndrome and Chronic Widespread Pain in Adolescence: Population Birth Cohort Study.
Norris, Tom, Deere, Kevin, Tobias, Jon H et al. · The journal of pain · 2017 · DOI
Quick Summary
This study looked at whether adolescents with ME/CFS (chronic fatigue syndrome) are more likely to also have chronic widespread pain. Researchers surveyed about 3,200 teenagers and found that those diagnosed with ME/CFS were nearly four times more likely to have widespread pain than those without ME/CFS. The study also found that depression and anxiety were more strongly linked to having both conditions together than to having either condition alone.
Why It Matters
This is among the first population-based studies examining the overlap between ME/CFS and chronic widespread pain in adolescents, a group understudied compared to adults. Understanding comorbidity patterns and shared psychological risk factors helps clinicians recognize and manage these conditions appropriately in young patients. The findings suggest that treatment approaches must account for both pain and fatigue components, particularly in adolescents with both conditions.
Observed Findings
2.6% of adolescents (82/3,214) met criteria for CFS; 4.5% (145/3,214) met criteria for CWP.
Adolescents with CFS had 3.87 times higher odds of also having CWP compared to those without CFS.
Female adolescents were approximately twice as likely to have either CFS or CWP; sex differences were greater for CWP than CFS.
14.6% of adolescents with CFS had comorbid CWP.
Depression and anxiety showed stronger associations with comorbid CFS/CWP than with exclusive CWP alone.
Inferred Conclusions
CFS and CWP show significant overlap in adolescents, with shared associations to depression and anxiety, suggesting possible common underlying mechanisms.
Female sex is a risk factor for both conditions, though the association is stronger for CWP.
Clinicians should screen for both conditions and consider depression and anxiety as relevant risk factors, particularly when both fatigue and pain are present.
The prevalence of overlap may be underestimated in this population-based study compared to specialist clinical samples.
Remaining Questions
What is the temporal relationship between CFS, CWP, depression, and anxiety—do they develop sequentially or concurrently?
What This Study Does Not Prove
This study cannot establish causality—it does not prove that ME/CFS causes pain, pain causes ME/CFS, or that depression/anxiety cause either condition. As a population-based study capturing mostly milder cases, the findings may not generalize to adolescents with severe ME/CFS seen in specialist services. The cross-sectional design means we cannot determine temporal relationships or rule out reverse causation.
Tags
Symptom:PainFatigue
Phenotype:Pediatric
Method Flag:PEM Not DefinedWeak Case DefinitionMixed Cohort
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 →