Malfliet, Anneleen, Van Oosterwijck, Jessica, Meeus, Mira et al. · Physiotherapy theory and practice · 2017 · DOI
This study looked at why some people with ME/CFS and fibromyalgia benefit more from a type of pain education (called pain neuroscience education) than others. The researchers found that patients who were very afraid of movement or who tended to worry a lot about their pain showed less improvement in their catastrophic thinking about pain after receiving this education. This suggests that for some patients, education alone may not be enough—they might need additional support to address their fears and worries.
Understanding which patients respond poorly to pain neuroscience education helps clinicians tailor treatments more effectively and identify who needs additional interventions. For ME/CFS patients, this research highlights that addressing fear of movement and unhelpful coping strategies alongside education may be necessary to achieve meaningful improvements in pain-related suffering.
This study does not prove that kinesiophobia and worry directly cause poor PNE response—only that they are associated with it. The small sample size (n=39) and observational design limit generalizability. The study does not establish what supplementary treatments would be most effective for these patient subgroups.
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
Malfliet, Anneleen, Van Oosterwijck, Jessica, Meeus, Mira, Cagnie, Barbara, Danneels, Lieven, Dolphens, Mieke, et al. (2017). Kinesiophobia and maladaptive coping strategies prevent improvements in pain catastrophizing following pain neuroscience education in fibromyalgia/chronic fatigue syndrome: An explorative study.. Physiotherapy theory and practice. https://doi.org/10.1080/09593985.2017.1331481
BibTeX
@article{mecfsatlas-malfliet-2017-kinesiophobia-maladaptive,
author = {Malfliet, Anneleen and Van Oosterwijck, Jessica and Meeus, Mira and Cagnie, Barbara and Danneels, Lieven and Dolphens, Mieke and Buyl, Ronald and Nijs, Jo},
title = {Kinesiophobia and maladaptive coping strategies prevent improvements in pain catastrophizing following pain neuroscience education in fibromyalgia/chronic fatigue syndrome: An explorative study.},
journal = {Physiotherapy theory and practice},
year = {2017},
doi = {10.1080/09593985.2017.1331481},
note = {PubMed: 28605207},
url = {https://www.mecfsatlas.com/evidence/malfliet-2017-kinesiophobia-maladaptive},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/malfliet-2017-kinesiophobia-maladaptive
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