Winger, Anette, Kvarstein, Gunnvald, Wyller, Vegard Bruun et al. · BMJ open · 2014 · DOI
This study looked at pain in teenagers with ME/CFS compared to healthy teenagers. Teenagers with ME/CFS experienced more pain overall, in more places (headaches, stomach, muscles, and joints), and had lower pain thresholds—meaning their bodies reacted to pressure more sensitively. The researchers found that pain significantly interfered with daily activities in those with ME/CFS.
Pain is a major but understudied symptom in adolescent ME/CFS. This study provides quantitative evidence that young people with ME/CFS have both heightened pain sensitivity and increased pain burden, suggesting potential neurobiological mechanisms (such as central sensitization) that warrant further investigation and may inform clinical management strategies.
This study does not establish causation or the mechanisms underlying lowered pain thresholds in CFS. The cross-sectional design means we cannot determine whether altered pain sensitivity exists before CFS onset or develops as a consequence of the illness. The study also cannot explain whether pain changes reflect central sensitization, peripheral neuropathy, or other physiological processes.
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
Winger, Anette, Kvarstein, Gunnvald, Wyller, Vegard Bruun, Sulheim, Dag, Fagermoen, Even, Småstuen, Milada Cvancarova, et al. (2014). Pain and pressure pain thresholds in adolescents with chronic fatigue syndrome and healthy controls: a cross-sectional study.. BMJ open. https://doi.org/10.1136/bmjopen-2014-005920
BibTeX
@article{mecfsatlas-winger-2014-pain-pressure,
author = {Winger, Anette and Kvarstein, Gunnvald and Wyller, Vegard Bruun and Sulheim, Dag and Fagermoen, Even and Småstuen, Milada Cvancarova and Helseth, Sølvi},
title = {Pain and pressure pain thresholds in adolescents with chronic fatigue syndrome and healthy controls: a cross-sectional study.},
journal = {BMJ open},
year = {2014},
doi = {10.1136/bmjopen-2014-005920},
note = {PubMed: 25287104},
url = {https://www.mecfsatlas.com/evidence/winger-2014-pain-pressure},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/winger-2014-pain-pressure
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