Accessible Requires Authentication Published by De Gruyter September 7, 2020

Pain in adolescent chronic fatigue following Epstein-Barr virus infection

Elias Myrstad Brodwall, Maria Pedersen, Tarjei Tørre Asprusten and Vegard Bruun Bratholm Wyller



Acute Epstein-Barr virus (EBV) infection is a trigger of Chronic Fatigue (CF) and Chronic Fatigue Syndrome (CFS). The aim of this cross-sectional study was to investigate pain symptoms and pressure pain thresholds in fatigued and non-fatigued adolescents six months after acute EBV-infection, and in healthy controls. This study is part of the CEBA-project (CF following acute EBV infection in adolescents).


A total of 195 adolescents (12–20 years old) that had undergone an acute EBV infection six months prior to assessment were divided into fatigued (EBV CF+) and non-fatigued (EBV CF−) cases based on questionnaire score. The EBV CF+ cases were further sub-divided according to case definitions of CFS. In addition, a group of seventy healthy controls was included. Symptoms were mapped with questionnaires. Pressure pain thresholds were measured through pressure algometry. One way ANOVA were used for between-group analyses. Linear regression analyses were used to explore associations between Pediatric Quality of Life (dependent variable), pain symptoms and other variables within the EBV (CF+) group.


The EBV CF+ group had significantly higher scores for pain symptoms as compared with the EBV CF− group and healthy controls, but pressure pain threshold did not differ significantly. The number of pain symptoms as well as pain severity were strongly and independently associated with quality of life.


CF and CFS following acute EBV-infection in adolescents is characterized by high pain symptom burden, which in turn is associated with a decline in quality of life. Pain in CF and CFS is of considerable clinical importance, and should be a focal point for further investigation and intervention in these patient groups.

Corresponding author: Vegard Bruun Bratholm Wyller, PhD, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; and Department of Paediatrics, Akershus University Hospital, Lørenskog, N-1478, Norway, Phone: +47 91 16 66 81, E-mail:

Funding source: Health South-East Hospital Trust


We thank Stine Andersen Ness, Dept. of Pediatrics and Adolescent Health, Akershus University Hospital for invaluable secretary assistance; Truls Leegaard, Dept. of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway and Trygve Tjade, Fürst Medical Laboratory, Lørenskog, Norway for administering EBV serology analyses; Kristin Godang, Section of Specialized Endocrinology, Dept. of Endocrinology, Oslo University Hospital, Norway, for laboratory analyses of norepinephrine; and Eva Skovlund, Dept. of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway for advices on statistical analyses.

  1. Research funding: This study was funded by the Health South-East Hospital Trust, Norway.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Informed consent: Informed consent has been obtained from all individuals included in this study.

  5. Ethical approval: The research related to human use complies with all the relevant national regulations, institutional policies and was performed in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.


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Received: 2020-03-02
Accepted: 2020-07-08
Published Online: 2020-09-07
Published in Print: 2020-10-25

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