Ramírez-Paesano, Carlos, Rodiera Clarens, Claudia, Sharp Segovia, Allan et al. · Orphanet journal of rare diseases · 2023 · DOI
Some people with Ehlers-Danlos syndrome (a connective tissue disorder) develop neck instability that causes severe pain and fatigue similar to ME/CFS. This review examines how doctors can better manage pain during and after neck surgery in these patients by using less opioid medication and combining multiple pain-relief strategies instead, because opioids often don't work well and can actually make pain worse in these cases.
This work is relevant to ME/CFS research because many ME/CFS patients experience overlapping features with EDS-HT (central sensitization, opioid ineffectiveness, widespread pain) and may benefit from opioid-sparing multimodal pain management strategies. Understanding how to manage severe pain without worsening central sensitization through opioid hyperalgesia has direct clinical implications for the ME/CFS population.
This review does not establish the efficacy of opioid-minimization protocols through controlled trial data or provide outcome comparisons between opioid-based and opioid-free approaches. It does not prove these strategies will be effective for ME/CFS patients specifically, nor does it demonstrate causation between the proposed mechanisms (neuroinflammation, central sensitization) and symptom severity in ME/CFS.
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
Ramírez-Paesano, Carlos, Rodiera Clarens, Claudia, Sharp Segovia, Allan, Coila Bustinza, Alan, Rodiera Olive, Josep, & Juanola Galceran, Albert (2023). Perioperative opioid-minimization approach as a useful protocol in the management of patients with Ehlers-Danlos syndrome-hypermobility type, craniocervical instability and severe chronic pain who are to undergo occipito-cervical fixation.. Orphanet journal of rare diseases. https://doi.org/10.1186/s13023-023-02829-9
BibTeX
@article{mecfsatlas-ramrez-paesano-2023-perioperative-opioid,
author = {Ramírez-Paesano, Carlos and Rodiera Clarens, Claudia and Sharp Segovia, Allan and Coila Bustinza, Alan and Rodiera Olive, Josep and Juanola Galceran, Albert},
title = {Perioperative opioid-minimization approach as a useful protocol in the management of patients with Ehlers-Danlos syndrome-hypermobility type, craniocervical instability and severe chronic pain who are to undergo occipito-cervical fixation.},
journal = {Orphanet journal of rare diseases},
year = {2023},
doi = {10.1186/s13023-023-02829-9},
note = {PubMed: 37491286},
url = {https://www.mecfsatlas.com/evidence/ramrez-paesano-2023-perioperative-opioid},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/ramrez-paesano-2023-perioperative-opioid
Contribute
Private, reviewed by a human. Not a public comment thread.