Meeus, Mira, Nijs, Jo, Van de Wauwer, Naomi et al. · Pain · 2008 · DOI
This study tested how quickly the body's natural pain-blocking system kicks in when ME/CFS patients experience heat pain compared to healthy people. Researchers immersed participants' arms in warm water and tracked pain levels over time. They found that people with ME/CFS have stronger pain sensations overall, and their bodies take longer to activate the natural pain-suppression mechanism that normally reduces pain during ongoing stimulation.
This research provides experimental evidence that ME/CFS involves a specific neurobiological deficit—delayed activation of the body's endogenous pain inhibition system—rather than simply heightened pain perception. Understanding this mechanism could guide development of targeted treatments to enhance pain suppression and help clinicians differentiate ME/CFS-related pain from other conditions. The findings also challenge the hypothesis that abnormal cortisol levels explain ME/CFS pain, refocusing research on central pain processing.
This study does not prove that delayed DNIC causes ME/CFS pain; it only demonstrates an association in a small sample at one time point. The findings cannot be generalized to all ME/CFS patients (only those with chronic pain were studied), and the study design cannot establish whether delayed pain inhibition is a primary defect, a secondary consequence of illness, or an epiphenomenon. The cortisol-pain correlation does not establish causation.
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
Meeus, Mira, Nijs, Jo, Van de Wauwer, Naomi, Toeback, Linda, & Truijen, Steven (2008). Diffuse noxious inhibitory control is delayed in chronic fatigue syndrome: an experimental study.. Pain. https://doi.org/10.1016/j.pain.2008.05.018
BibTeX
@article{mecfsatlas-meeus-2008-diffuse-noxious,
author = {Meeus, Mira and Nijs, Jo and Van de Wauwer, Naomi and Toeback, Linda and Truijen, Steven},
title = {Diffuse noxious inhibitory control is delayed in chronic fatigue syndrome: an experimental study.},
journal = {Pain},
year = {2008},
doi = {10.1016/j.pain.2008.05.018},
note = {PubMed: 18617327},
url = {https://www.mecfsatlas.com/evidence/meeus-2008-diffuse-noxious},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/meeus-2008-diffuse-noxious
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