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

Winger, Anette; Kvarstein, Gunnvald; Wyller, Vegard Bruun; Sulheim, Dag; Fagermoen, Even; Småstuen, Milada Cvancarova; Helseth, Sølvi

doi:10.1136/bmjopen-2014-005920

Cited by 30 publications

(25 citation statements)

References 56 publications

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“…Previous MRI reports in CFS have suggested that regulatory brain regions themselves might be unaffected, but a collective dysregulation has been observed in two-way signaling and correlated functions [ 42 , 43 ]. We have reported that cognition [ 44 ], pain [ 45 ] and physical activity [ 46 ] are three domains of impaired function in adolescent CFS. These functional domains are likewise associated with the efficiency of right dAI connectivity and cognitive control in healthy participants [ 15 , 17 , 20 , 47 – 49 ].…”

Section: Introductionmentioning

confidence: 99%

Altered right anterior insular connectivity and loss of associated functions in adolescent chronic fatigue syndrome

et al. 2017

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Impairments in cognition, pain intolerance, and physical inactivity characterize adolescent chronic fatigue syndrome (CFS), yet little is known about its neurobiology. The right dorsal anterior insular (dAI) connectivity of the salience network provides a motivational context to stimuli. In this study, we examined regional functional connectivity (FC) patterns of the right dAI in adolescent CFS patients and healthy participants. Eighteen adolescent patients with CFS and 18 aged-matched healthy adolescent control participants underwent resting-state functional magnetic resonance imaging. The right dAI region of interest was examined in a seed-to-voxel resting-state FC analysis using SPM and CONN toolbox. Relative to healthy adolescents, CFS patients demonstrated reduced FC of the right dAI to the right posterior parietal cortex (PPC) node of the central executive network. The decreased FC of the right dAI–PPC might indicate impaired cognitive control development in adolescent CFS. Immature FC of the right dAI–PPC in patients also lacked associations with three known functional domains: cognition, pain and physical activity, which were observed in the healthy group. These results suggest a distinct biological signature of adolescent CFS and might represent a fundamental role of the dAI in motivated behavior.

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Section: Introductionmentioning

confidence: 99%

Altered right anterior insular connectivity and loss of associated functions in adolescent chronic fatigue syndrome

et al. 2017

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“…In total, we identified 26 RCTs or observational studies that investigated treatment interventions in paediatric CFS/ME. However, 19 of these studies did not measure pain at any time point,24–43 and two studies measured pain at a single time point only 10 44. They were therefore excluded from this review.…”

Section: Resultsmentioning

confidence: 99%

“…However, the aetiology and pathophysiology of pain in this population is poorly understood and current treatment approaches do not target pain 10 11. This systematic review aimed to identify what interventions, if any, have been used to treat pain in children with CFS/ME, and to establish whether interventions used to treat paediatric CFS/ME change pain scores at follow-up.…”

Section: Introductionmentioning

confidence: 99%

Interventions to treat pain in paediatric CFS/ME: a systematic review

Ascough

King

Serafimova

et al. 2020

bmjpo

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BackgroundPaediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is common (prevalence 1%–2%). Two-thirds of children experience moderate or severe pain, which is associated with increased fatigue and poorer physical function. However, we do not know if treatment for CFS/ME improves pain.ObjectiveIdentify whether specialist treatment of paediatric CFS/ME improves pain.MethodsWe conducted a detailed search in MEDLINE, EMBASE, PsycINFO and the Cochrane Library. Two researchers independently screened texts published between 1994 and 24 January 2019 with no language restrictions. Inclusion criteria were (1) randomised controlled trials and observational studies; (2) participants aged <19 years with CFS/ME; and (3) measure of pain before and after an intervention.ResultsOf 1898 papers screened, 26 studies investigated treatment for paediatric CFS/ME, 19 of which did not measure pain at any time point. Only five treatment studies measured pain at baseline and follow-up and were included in this review. None of the interventions were specifically targeted at treating pain. Of the included studies, two showed no improvement in pain scores, one suggested an improvement in one subgroup and two studies identified improvements in pain measures in ‘recovered’ patients compared with ‘non-recovered’ patients.ConclusionsDespite the prevalence and impact of pain in children with CFS/ME surprisingly few treatment studies measured pain. In those that did measure pain, the treatments used focused on overall management of CFS/ME and we identified no treatments that were targeted specifically at managing pain. There is limited evidence that treatment helps improve pain scores. However, patients who recover appear to have less pain than those who do not recover. More studies are needed to determine if pain in paediatric CFS/ME requires a specific treatment approach, with a particular focus on patients who do not recover following initial treatment.PROSPERO registration numberCRD42019117540.

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“…The pain component and pathophysiology of CFS are still poorly understood . Previous studies indicate that inflammatory cytokines play an important role in neurogenic inflammation and subsequent generation of neuropathic pain in patients with CFS . Therefore, the hemostatic levels of pro‐ and anti‐inflammatory cytokines may play a pivotal role in evaluating and estimating the chronic pain state .…”

Section: Discussionmentioning

confidence: 99%

MicroRNAs as Biomarkers of Pain Intensity in Patients With Chronic Fatigue Syndrome

2019

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Background Numerous experimental models have shown that microRNAs (miRNAs)play an important role in regulating pain processing in clinical pain disorders. In this study, we evaluated a set of miRNAs as diagnostic biomarkers of pain intensity in adolescents with chronic fatigue syndrome (CFS). We then correlated the expression of these miRNAs with the levels of inflammatory markers and pain‐related comorbidities in adolescents with CFS and healthy controls (HCs). Methods A total of 150 adolescents, 12 to 18 years of age, participated in this study between April 2016 and April 2017. The participants were classified into 2 groups: adolescents with CFS (n = 100) and HCs (n = 50). Reverse‐transcription polymerase chain reaction was used to evaluate the expression of miR‐558, miR‐146a, miR‐150, miR‐124, and miR‐143. Immunoassay analysis was used to assess the levels of immune inflammatory markers interleukin‐6 (IL‐6), tumor necrosis factor‐α (TNF‐α), and cyclooxygenase‐2 (COX‐2). Results Adolescents with CFS showed significantly higher pain thresholds than comparable nonfatigued HCs. Ability to enjoy life and relations with others were the parameters least influenced by pain in CFS patients. Differential expression of miR‐558, miR‐146a, miR‐150, miR‐124, and miR‐143 was significantly downregulated and notably interfered with pain intensity and frequency in patients with CFS. Also, the expression of these miRNAs was significantly correlated with that of IL‐6, TNF‐α, and COX‐2, which have been shown to mediate pain intensity in patients with CFS. Girls with CFS showed significantly decreased expression levels of these miRNAs compared with the levels of boys with CFS. Girls with CFS also showed increased expression of the inflammatory pain–related markers IL‐6, TNF‐α, and COX‐2 compared with the levels of boys with CFS. Conclusions The intensity and consequences of pain were influenced by differential expression of miR‐558, miR‐146a, miR‐150, miR‐124, and miR‐143, which was directly associated with higher expression of the immune inflammatory‐related genes TNFα, IL‐6, and COX‐2 in adolescents with CFS. Further studies of larger patient cohorts will help clarify the role of miRNAs in the pathogenesis of CFS.

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

Cited by 30 publications

References 56 publications

Altered right anterior insular connectivity and loss of associated functions in adolescent chronic fatigue syndrome

Altered right anterior insular connectivity and loss of associated functions in adolescent chronic fatigue syndrome

Interventions to treat pain in paediatric CFS/ME: a systematic review

MicroRNAs as Biomarkers of Pain Intensity in Patients With Chronic Fatigue Syndrome

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