Oosterman, Joukje M, van der Schaaf, Marieke, de Kleijn, Willemien P E et al. · Journal of psychosomatic research · 2025 · DOI
This study looked at how fatigue and pain affect thinking and memory problems in people with ME/CFS. Researchers tested 1,375 patients on tasks like reaction time and attention, and found that both fatigue severity and pain severity were linked to worse cognitive performance. The effects were stronger in older patients, suggesting that age may play a role in how much fatigue and pain impact thinking abilities.
Understanding which ME/CFS symptoms most affect cognition helps patients and clinicians prioritize symptom management strategies. This research suggests that treating pain and fatigue together, rather than separately, may be important for preserving cognitive function. The age-related findings could inform how cognitive difficulties are evaluated and managed differently across the lifespan of ME/CFS patients.
This study cannot establish causation—it only shows that fatigue and pain are associated with lower cognitive performance, not that they directly cause it. The cross-sectional design means researchers cannot determine whether severe symptoms harm cognition, whether reduced cognitive function worsens symptoms, or whether a third factor affects both. This research does not prove that reducing fatigue and pain will improve cognition.
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
Oosterman, Joukje M, van der Schaaf, Marieke, de Kleijn, Willemien P E, Kuut, Tanja A, Brazil, Inti A, & Knoop, Hans (2025). The association of fatigue and pain with cognitive test performance in patients with myalgic encephalomyelitis/chronic fatigue syndrome.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2025.112401
BibTeX
@article{mecfsatlas-oosterman-2025-association-fatigue,
author = {Oosterman, Joukje M and van der Schaaf, Marieke and de Kleijn, Willemien P E and Kuut, Tanja A and Brazil, Inti A and Knoop, Hans},
title = {The association of fatigue and pain with cognitive test performance in patients with myalgic encephalomyelitis/chronic fatigue syndrome.},
journal = {Journal of psychosomatic research},
year = {2025},
doi = {10.1016/j.jpsychores.2025.112401},
note = {PubMed: 41101039},
url = {https://www.mecfsatlas.com/evidence/oosterman-2025-association-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/oosterman-2025-association-fatigue
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