Creavin, Samuel T, Dunn, Kate M, Mallen, Christian D et al. · European journal of pain (London, England) · 2010 · DOI
This study looked at how often pain and fatigue occur together in everyday people. Researchers found that when someone has chronic widespread pain, they are much more likely to also experience persistent fatigue, and vice versa. People who had both symptoms were more likely to also experience anxiety or depression, and certain factors like being overweight, having other chronic diseases, or low activity levels made having both symptoms more common.
For ME/CFS patients, this study is important because it documents that pain and fatigue commonly co-occur in the general population and identifies shared risk factors. Understanding that anxiety and depression are more common in people with both symptoms highlights the need for integrated psychological and physical treatment approaches. The findings suggest that ME/CFS—which often involves both prominent fatigue and widespread pain—should not be viewed as two separate conditions but as interconnected symptoms requiring holistic clinical attention.
This study does not establish causation; it only documents correlation and co-occurrence. It does not identify whether pain causes fatigue, fatigue causes pain, or if a third factor causes both. The study also does not focus specifically on ME/CFS but rather examines pain and fatigue as separate symptoms in the general population, so findings may not directly apply to ME/CFS pathophysiology.
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
Creavin, Samuel T, Dunn, Kate M, Mallen, Christian D, Nijrolder, Iris, & van der Windt, Daniëlle A W M (2010). Co-occurrence and associations of pain and fatigue in a community sample of Dutch adults.. European journal of pain (London, England). https://doi.org/10.1016/j.ejpain.2009.05.010
BibTeX
@article{mecfsatlas-creavin-2010-occurrence-associations,
author = {Creavin, Samuel T and Dunn, Kate M and Mallen, Christian D and Nijrolder, Iris and van der Windt, Daniëlle A W M},
title = {Co-occurrence and associations of pain and fatigue in a community sample of Dutch adults.},
journal = {European journal of pain (London, England)},
year = {2010},
doi = {10.1016/j.ejpain.2009.05.010},
note = {PubMed: 19540139},
url = {https://www.mecfsatlas.com/evidence/creavin-2010-occurrence-associations},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/creavin-2010-occurrence-associations
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