Pain syndromes, disability, and chronic disease in childhood.
Malleson, P N · Current opinion in rheumatology · 1991 · DOI
Quick Summary
This editorial discusses how chronic pain and long-term illnesses affect children, and suggests that conditions like fibromyalgia and chronic fatigue syndrome (ME/CFS) may be related to each other. The author notes that doctors need better training to understand these complex conditions and that psychological factors may play a role in how these illnesses develop and affect children's lives.
Why It Matters
This editorial highlights the clinical recognition of ME/CFS as a serious pediatric condition requiring multidisciplinary management and focused research attention. It suggests potential mechanistic links between ME/CFS and other chronic pain syndromes, and raises the question of whether immunologic abnormalities contribute to ME/CFS pathophysiology—both areas of ongoing clinical interest.
Observed Findings
Childhood disability and chronic disease prevalence is increasing
Pediatric rheumatologists manage many children with chronic and recurrent musculoskeletal pain
Immunoglobulin subclass deficiencies are being identified in chronic fatigue syndrome and other disease states
Short stature occurs in many chronic illnesses
Psychosocial problems appear to be common contributing factors across multiple chronic pain syndromes
Inferred Conclusions
Reflex neurovascular dystrophy, fibromyalgia, and chronic fatigue syndrome may represent related conditions on a disease continuum
Psychosocial factors likely contribute to the pathogenesis and presentation of chronic pain syndromes in children
Physician training must improve to address the complexity of childhood disability and multidisciplinary management
Immunologic mechanisms warrant further investigation in ME/CFS, though clinical significance remains unclear
Remaining Questions
Do reflex neurovascular dystrophy, fibromyalgia, and ME/CFS share common biological mechanisms or are they distinct disorders?
What This Study Does Not Prove
This editorial does not provide empirical evidence that ME/CFS, fibromyalgia, and reflex neurovascular dystrophy are actually part of a disease continuum—it merely proposes this as a possibility. It does not establish causality between psychosocial factors and ME/CFS, nor does it clarify the clinical significance of immunoglobulin subclass deficiencies in ME/CFS. As an editorial, it represents expert opinion rather than systematic review or original research data.
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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