Warren, John W, Clauw, Daniel J, Wesselmann, Ursula et al. · Journal of psychosomatic research · 2014 · DOI
This study looked at women with bladder pain syndrome/interstitial cystitis (BPS/IC) to understand why some had hysterectomies (surgical removal of the uterus). Researchers found that women who developed new cases of chronic pelvic pain or irritable bowel syndrome, or who had multiple other chronic pain and fatigue conditions at the start of the study, were more likely to undergo hysterectomy. The authors suggest that before having surgery for pain, patients with these conditions should first try non-surgical treatments.
ME/CFS patients frequently experience overlapping functional somatic syndromes including fibromyalgia and chronic pain conditions. This study highlights the importance of recognizing clusters of functional syndromes as risk factors for unnecessary surgery, suggesting that patients with ME/CFS and related conditions should exhaust conservative treatment options before pursuing surgical interventions for pain.
This study does not prove that functional somatic syndromes cause hysterectomy decisions; rather, it identifies associations. The study does not establish whether hysterectomy actually improves symptoms or whether the patient's syndrome cluster, physician bias, or both influenced surgical recommendations. Generalizability to other populations and other surgical procedures remains unknown.
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
Warren, John W, Clauw, Daniel J, Wesselmann, Ursula, Howard, Fred M, Gallicchio, Lisa, & Morozov, Vadim (2014). Functional somatic syndromes as risk factors for hysterectomy in early bladder pain syndrome/interstitial cystitis.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2014.09.004
BibTeX
@article{mecfsatlas-warren-2014-functional-somatic,
author = {Warren, John W and Clauw, Daniel J and Wesselmann, Ursula and Howard, Fred M and Gallicchio, Lisa and Morozov, Vadim},
title = {Functional somatic syndromes as risk factors for hysterectomy in early bladder pain syndrome/interstitial cystitis.},
journal = {Journal of psychosomatic research},
year = {2014},
doi = {10.1016/j.jpsychores.2014.09.004},
note = {PubMed: 25258358},
url = {https://www.mecfsatlas.com/evidence/warren-2014-functional-somatic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/warren-2014-functional-somatic
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