Orthostatic stress testing in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients with or without concomitant fibromyalgia: effects on pressure pain thresholds and temporal summation

Abstract

Introduction: muscle pain/fibromyalgia (FM) is common among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We recently demonstrated that during orthostatic stress testing, adults with ME/CFS reported increased pain. In the current study, we hypothesized that pain pressure thresholds (PPT) would decrease and temporal summation (windup) would increase after head-up tilt testing (HUT), and that the presence of co-morbid FM would be associated with greater change in both measures. Methods and Results: 248 ME/CFS patients (164 with FM and84 without FM), and 22 healthy controls (HC) were analyzed. In HC there were no significant differences in PPT between pre-and post-HUT (finger: from 4.7(1.6) to 4.4(1.5); shoulder: from 2.8(1.0) to 2.9(1.0)). In ME/CFS patients with and without FM, a significant decrease in PPT post-HUT was found compared to HC (both p<0.0001). Patients with FM had a lower PPT pre-and post-HUT (finger: from 2.0(0.9) to 1.5(0.8); shoulder: from 1.2(0.5) to 1.0(0.5) compared to patients without FM (finger: from 5.0(1.6) to 3.3(1.5); shoulder: from 2.2(0.9) to1.9(1.0) (p ranging from 0.001 to <0.0001). In contrast to HC in ME/CFS patients windup was increased compared to HC pre-HUT (both p<0.0001), but did not significantly change post-HUT. Conclusions: Pressure pain threshold decreased in ME/CFS patients with or without fibromyalgia after head-up tilt test (HUT), compared to healthy controls. Windup pre-and post-HUT was significantly higher compared to healthy controls, but did not change from pre-to post-HUT. These results demonstrate that, like exercise, orthostatic stress can negatively influence the physiology of pain perception in ME/CFS.

Submaximal Exercise Provokes Increased Activation of the Anterior Default Mode Network During the Resting State as a Biomarker of Postexertional Malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

“…Deficits in these regions may correlate to the persistent visceral symptoms experienced in CFS. The general trend for lower BOLD signal at rest in CFS compared to controls is consistent with the general reduction in cerebral blood flow and reports of orthostatic intolerance that are recurrent findings in CFS ( Razumovsky et al, 2003 ; Yoshiuchi, 2006 ; Pardini et al, 2010 ; Tajima et al, 2010 ; Biswal et al, 2011 ; Stewart et al, 2011 ; Ocon et al, 2012 ; Medow et al, 2014 ; Gay et al, 2016 ; Finkelmeyer et al, 2018 ; van Campen et al, 2020a , b , c ).…”

Numeric Rating Scales Show Prolonged Post-exertional Symptoms After Orthostatic Testing of Adults With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

“…Extending these findings, we show that working memory function, as assessed by the n-back test, decreased immediately after HUT (35). Furthermore, we show a decrease in pressure pain thresholds (PPT) immediately after orthostatic stress similar to PPT changes in ME/CFS patients after an exercise stressor (36). We, therefore, hypothesize that the symptom perception increase as demonstrated by the increases in the severity of NRS ratings of pain, fatigue, and concentration increase, is related to the observed reduction in CBF.…”