Van Oosterwijck, J, Nijs, J, Meeus, M et al. · Journal of internal medicine · 2010 · DOI
This study compared how the body's pain-relief systems work in people with ME/CFS versus healthy people during exercise. Researchers found that after exercise, people with ME/CFS became more sensitive to pain (their pain thresholds decreased), while healthy people became less sensitive to pain. The ME/CFS group also experienced worsening symptoms after both types of exercise they tried.
This study provides objective neurobiological evidence that ME/CFS involves abnormal pain processing during and after exertion, challenging assumptions that postexertional malaise is purely psychological. Understanding this mechanism could eventually guide development of exercise strategies that minimize symptom exacerbation and inform treatment approaches targeting central pain sensitization.
This study demonstrates association, not causation—it shows that abnormal pain thresholds occur alongside postexertional malaise but does not establish whether pain processing changes cause PEM or are merely correlated with it. The findings are limited to women and may not generalize to men with ME/CFS. The study does not identify which specific exercise characteristics (intensity, duration, type) are safest or most harmful.
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 Oosterwijck, J, Nijs, J, Meeus, M, Lefever, I, Huybrechts, L, Lambrecht, L, et al. (2010). Pain inhibition and postexertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: an experimental study.. Journal of internal medicine. https://doi.org/10.1111/j.1365-2796.2010.02228.x
BibTeX
@article{mecfsatlas-van-oosterwijck-2010-pain-inhibition,
author = {Van Oosterwijck, J and Nijs, J and Meeus, M and Lefever, I and Huybrechts, L and Lambrecht, L and Paul, L},
title = {Pain inhibition and postexertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: an experimental study.},
journal = {Journal of internal medicine},
year = {2010},
doi = {10.1111/j.1365-2796.2010.02228.x},
note = {PubMed: 20412374},
url = {https://www.mecfsatlas.com/evidence/van-oosterwijck-2010-pain-inhibition},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/van-oosterwijck-2010-pain-inhibition
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