van Campen, C Linda M C, Rowe, Peter C, Verheugt, Freek W A et al. · Clinical and experimental rheumatology · 2021 · DOI
This study tested how standing up quickly (which can trigger ME/CFS symptoms) affects pain sensitivity in ME/CFS patients. Researchers measured how much pressure patients could tolerate on their finger and shoulder before and after a tilt test. They found that ME/CFS patients became more pain-sensitive after the tilt test, meaning their bodies responded to pain more strongly than healthy people, and this effect was even more pronounced in those who also had fibromyalgia.
This research provides objective evidence that physical stressors like orthostatic changes directly worsen pain perception in ME/CFS, supporting patient experiences of increased pain during symptom flares. Understanding these pain mechanisms may eventually help develop targeted treatments to reduce post-exertional symptom worsening, a hallmark of ME/CFS.
This study demonstrates correlation between orthostatic stress and decreased pain thresholds but does not establish the specific biological mechanisms causing this change. It also cannot prove that orthostatic stress is the primary driver of pain in ME/CFS, only that it acutely influences pain perception during testing. The findings may not generalize to other types of physical or cognitive stressors.
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
van Campen, C Linda M C, Rowe, Peter C, Verheugt, Freek W A, & Visser, Frans C (2021). Orthostatic stress testing in myalgic encephalomyelitis/chronic fatigue syndrome patients with or without concomitant fibromyalgia: effects on pressure pain thresholds and temporal summation.. Clinical and experimental rheumatology. https://doi.org/10.55563/clinexprheumatol/1qj9zu
BibTeX
@article{mecfsatlas-van-campen-2021-orthostatic-stress,
author = {van Campen, C Linda M C and Rowe, Peter C and Verheugt, Freek W A and Visser, Frans C},
title = {Orthostatic stress testing in myalgic encephalomyelitis/chronic fatigue syndrome patients with or without concomitant fibromyalgia: effects on pressure pain thresholds and temporal summation.},
journal = {Clinical and experimental rheumatology},
year = {2021},
doi = {10.55563/clinexprheumatol/1qj9zu},
note = {PubMed: 32940215},
url = {https://www.mecfsatlas.com/evidence/van-campen-2021-orthostatic-stress},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/van-campen-2021-orthostatic-stress
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