Afari, Niloofar, Buchwald, Dedra, Clauw, Daniel et al. · The Clinical journal of pain · 2020 · DOI
This study compared people with chronic pelvic pain conditions to people with other widespread chronic pain conditions like fibromyalgia and chronic fatigue syndrome, as well as healthy volunteers. Researchers found that while these conditions affect different parts of the body, people with all these conditions share similar emotional and psychological challenges—like anxiety, depression, and stress—suggesting they may share common underlying causes. The study suggests that treating these conditions effectively may require addressing both physical pain and psychological factors together.
This research is important because it provides evidence that ME/CFS shares underlying biological and psychological mechanisms with other chronic pain conditions, validating the multisystem nature of ME/CFS. Understanding these commonalities could lead to more integrated treatment approaches and improved clinical recognition that ME/CFS patients may benefit from comprehensive psychosocial assessment and interventions alongside biomedical management.
This study does not prove that ME/CFS causes or is caused by the same mechanism as urological chronic pelvic pain—only that they share some common symptom patterns and psychological associations. The cross-sectional design means researchers cannot determine whether psychological symptoms precede physical symptoms or result from them. The study also does not establish that psychosocial interventions are the primary treatment needed; finding psychological similarities does not mean the underlying condition is primarily psychological.
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 →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Afari, Niloofar, Buchwald, Dedra, Clauw, Daniel, Hong, Barry, Hou, Xiaoling, Krieger, John N, et al. (2020). A MAPP Network Case-control Study of Urological Chronic Pelvic Pain Compared With Nonurological Pain Conditions.. The Clinical journal of pain. https://doi.org/10.1097/AJP.0000000000000769
BibTeX
@article{mecfsatlas-afari-2020-mapp-network,
author = {Afari, Niloofar and Buchwald, Dedra and Clauw, Daniel and Hong, Barry and Hou, Xiaoling and Krieger, John N and Mullins, Chris and Stephens-Shields, Alisa J and Gasperi, Marianna and Williams, David A and MAPP Research Network},
title = {A MAPP Network Case-control Study of Urological Chronic Pelvic Pain Compared With Nonurological Pain Conditions.},
journal = {The Clinical journal of pain},
year = {2020},
doi = {10.1097/AJP.0000000000000769},
note = {PubMed: 31794439},
url = {https://www.mecfsatlas.com/evidence/afari-2020-mapp-network},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/afari-2020-mapp-network
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