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Licensed Unlicensed Requires Authentication Published by De Gruyter October 16, 2018

Pain is associated with reduced quality of life and functional status in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Elin Bolle Strand EMAIL logo , Anne Marit Mengshoel , Leiv Sandvik , Ingrid B. Helland , Semhar Abraham and Lise Solberg Nes


Background and aims

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is challenging to live with, often accompanied by pervasive fatigue and pain, accompanied by decreased quality of life (QoL) as well as anxiety and/or depression. Associations between higher pain, lower QoL and higher anxiety and depression have been shown in patients with various chronic pain disorders. Few studies have however examined such associations in a sample of patients with ME/CFS. The aims of the current study were to examine the impact of pain levels and compare levels of pain, health related QoL, anxiety and depression between patients with ME/CFS and healthy controls. In addition, the study aimed and to examine these relationships within the patient group only.


This is a cross-sectional questionnaire based study comparing 87 well-diagnosed patients with ME/CFS with 94 healthy controls. The De Paul Symptom Questionnaire (DSQ), the Medical Outcomes Study Short-Form Surveys (SF-36) and the Hospital Anxiety and Depression Scale (HADS) were used to examine and compare pain, physical function, QoL, anxiety and depression in patients and healthy controls. Further the pain variables were divided into pain total, pain intensity and a pain frequency score for analyses of the above mentioned variables within the patient group only.


Significantly higher levels of pain, anxiety and depression, and lower levels of QoL were found in the patient group compared with healthy controls. For the patient group alone, pain was significantly associated with lower QoL in terms of physical functioning, bodily pain, general health functioning, vitality and social functioning capacity. In this patient sample, only frequency of joint pain showed significant difference in psychological variables such as depression and anxiety – depression combined.


ME/CFS patients differ significantly from healthy controls in pain, health related QoL, anxiety and depression. Pain is significantly associated with reduced QoL and overall a lower level of functioning. The relation between pain and anxiety and depression appears less clear.


Pain is for many ME/CFS patients associated with reduced physical functioning and reduced QoL. A thorough pain assessment can therefore be essential for clinicians, and subsequent medical pain treatment combined with good pain coping skills may increase functioning level and QoL for these patients. The link between joint pain and psychological factors should also be focused in clinical practice in terms of mapping and counseling. Pain should be further examined to understand the importance it may have for functioning level as reduced function is a main criteria when diagnosing the patients.


We want to thank research nurse Hilde Haukeland for her contribution in the data sampling of this project and the participants who provided us with valuable data.

  1. Authors’ statements

  2. Research funding: Funding for the CFS/ME biobank and thematic register data sampling was received from the Norwegian National Health directory.

  3. Conflict of interest: The authors report no conflicts of interest in this work.

  4. Informed consent: All participants in this study received information about the study and gave their consent to attend.

  5. Ethical approval: Regional Ethical Committee (ref REK 2011/473, and REK South-East, ref: 2017/375) has approved the current study.

  6. Author contributions: All authors were involved in planning and design of the study. EBS and SA were responsible for data collection. LS, EBS, AMM and LSN were responsible for data analysis. All authors were involved in drafting and revising of the manuscript.


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Received: 2018-05-25
Revised: 2018-08-27
Accepted: 2018-09-03
Published Online: 2018-10-16
Published in Print: 2019-01-28

©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved

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