Landmark, Live, Sunde, Hans Fredrik, Fors, Egil A et al. · European journal of pain (London, England) · 2026 · DOI
This study looked at how multiple physical symptoms often occur together in people with chronic pain, using a framework called Bodily Distress Syndrome (BDS). Among 3,762 people attending a specialized pain clinic, 92.5% showed moderate to severe BDS, and those with BDS experienced more severe symptoms and psychological stress. After one year, people with BDS improved less and reported less benefit from treatment compared to those without BDS.
Because ME/CFS patients commonly present with multisystem symptoms similar to BDS (fatigue, pain, cognitive dysfunction, sleep disturbance), understanding BDS prevalence and prognostic significance in pain populations may help clinicians identify complex symptom patterns earlier and tailor interdisciplinary treatment approaches. The framework's association with poorer long-term outcomes supports the need for mechanism-oriented interventions targeting the underlying drivers of symptom clusters in post-infectious and functional disorders.
This study does not establish causation—it shows that BDS severity correlates with worse outcomes but does not prove that BDS causes poor prognosis. The findings are specific to a tertiary pain clinic population and may not apply to ME/CFS populations, general practice, or mild pain populations. The study cannot determine whether BDS is a distinct disease entity or a phenotypic description of overlapping functional somatic conditions.
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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