Bourke, J H, Johnson, A L, Sharpe, M et al. · Psychological medicine · 2014 · DOI
This study looked at whether four different ME/CFS treatments—cognitive behavioral therapy (CBT), graded exercise therapy (GET), adaptive pacing therapy (APT), and standard medical care—could reduce pain symptoms. Both CBT and GET appeared to reduce muscle and joint pain more than APT or standard care, though the improvements were modest in size. Importantly, these pain improvements happened independently of whether fatigue got better.
Pain is a major, often-overlooked symptom of ME/CFS that significantly impacts quality of life. Understanding which treatments, if any, can reduce pain helps patients and clinicians make informed decisions about management approaches and highlights pain as a distinct symptom worthy of targeted intervention research.
This study does not prove that CBT or GET are safe or beneficial for all ME/CFS patients, as pain reduction alone does not address whether these treatments cause harm in other domains (e.g., post-exertional malaise worsening). The small effect sizes and modest real-world differences mean pain improvements may not be clinically meaningful for individual patients. The analysis cannot determine whether pain reduction reflects true biological change or reporting bias influenced by therapeutic expectation.
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
Bourke, J H, Johnson, A L, Sharpe, M, Chalder, T, & White, P D (2014). Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial.. Psychological medicine. https://doi.org/10.1017/S0033291713002201
BibTeX
@article{mecfsatlas-bourke-2014-pain-chronic,
author = {Bourke, J H and Johnson, A L and Sharpe, M and Chalder, T and White, P D},
title = {Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial.},
journal = {Psychological medicine},
year = {2014},
doi = {10.1017/S0033291713002201},
note = {PubMed: 23967878},
url = {https://www.mecfsatlas.com/evidence/bourke-2014-pain-chronic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/bourke-2014-pain-chronic
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