Nijs, Jo, Meeus, Mira, De Meirleir, Kenny · Manual therapy · 2006 · DOI
Many people with ME/CFS experience muscle and joint pain that can be even more bothersome than the fatigue itself. This review found that while some people with ME/CFS have naturally flexible joints, this doesn't seem to cause their pain. However, the way people think about their pain—such as catastrophizing or assuming the worst—plays a big role in how much pain they feel. The body's response to exercise appears to create extra stress on muscles in ME/CFS patients, which explains why exercise can make pain worse rather than better.
This study highlights that musculoskeletal pain in ME/CFS involves both physical (oxidative stress, altered pain processing) and psychological (catastrophizing) mechanisms, suggesting treatment requires a multi-faceted approach. Understanding these mechanisms helps clinicians design safer rehabilitation strategies that don't worsen postexertional malaise, a defining feature of ME/CFS.
This review does not prove that pain catastrophizing or exercise-induced oxidative stress *causes* ME/CFS, only that these factors contribute to pain severity. It does not establish causation for the dysfunctional pain processing system. The recommendations for pacing and education are not yet validated through rigorous trials in ME/CFS populations.
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
Nijs, Jo, Meeus, Mira, & De Meirleir, Kenny (2006). Chronic musculoskeletal pain in chronic fatigue syndrome: recent developments and therapeutic implications.. Manual therapy. https://doi.org/10.1016/j.math.2006.03.008
BibTeX
@article{mecfsatlas-nijs-2006-chronic-musculoskeletal,
author = {Nijs, Jo and Meeus, Mira and De Meirleir, Kenny},
title = {Chronic musculoskeletal pain in chronic fatigue syndrome: recent developments and therapeutic implications.},
journal = {Manual therapy},
year = {2006},
doi = {10.1016/j.math.2006.03.008},
note = {PubMed: 16781183},
url = {https://www.mecfsatlas.com/evidence/nijs-2006-chronic-musculoskeletal},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/nijs-2006-chronic-musculoskeletal
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