E2 ModeratePreliminaryPEM not requiredCross-SectionalPeer-reviewedReviewed
Standard · 3 min
The impact of COVID-19 stress on pain and fatigue in people with and without a central sensitivity syndrome.
Koppert, Tim Y, Jacobs, Johannes W G, Lumley, Mark A et al. · Journal of psychosomatic research · 2021 · DOI
Quick Summary
This study looked at whether pandemic-related stress made pain and fatigue worse in people with central sensitivity syndromes (conditions like ME/CFS and fibromyalgia) compared to those without these conditions. Researchers surveyed Dutch participants before COVID-19 (2018) and during the pandemic peak (2020), measuring stress levels, symptom severity, and psychological flexibility (the ability to adapt to difficult emotions). Surprisingly, the study found that while stress and symptom severity were generally linked, having a central sensitivity syndrome did not make people more vulnerable to stress-related symptom worsening.
Why It Matters
Understanding whether external stressors like pandemics disproportionately worsen symptoms in ME/CFS could inform treatment strategies and help patients better manage their condition. This study challenges the assumption that central sensitivity syndromes are particularly stress-reactive, suggesting that the relationship between stress and symptom severity may be more complex than previously thought.
Observed Findings
Higher pandemic worry and stress were associated with more severe somatic symptoms in the overall sample (β=0.14, p<0.0001).
People with central sensitivity syndromes reported more severe somatic symptoms overall (β=0.40, p<0.0001) than those without CSS.
Lower psychological flexibility was associated with more severe symptoms in the overall sample (β=-0.33, p<0.0001).
The association between pandemic stress and symptom severity was not significantly stronger in people with CSS (β=-0.026 to -0.037, p>0.22).
Psychological flexibility did not buffer the impact of stress on symptoms in the CSS group.
Inferred Conclusions
COVID-19-related stress does not disproportionately exacerbate somatic symptoms in people with central sensitivity syndromes compared to those without CSS.
Psychological flexibility does not appear to protect people with CSS from stress-related symptom worsening during the pandemic.
The impact of COVID-19 stress on somatic symptoms is uncertain and may depend on factors not captured in this study.
Remaining Questions
Why does having CSS not increase vulnerability to stress-related symptom exacerbation, contrary to prior hypotheses about central sensitization?
What This Study Does Not Prove
This study does not prove that stress does not affect ME/CFS symptoms—it only found weak associations in this specific pandemic context. The cross-sectional design cannot establish causation, and the findings may not generalize to other types of stress or to different populations. Additionally, the study's reliance on self-reported questionnaires rather than objective symptom measures may miss important symptom changes.
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 →
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