Pain-related post-exertional malaise in (ME/CFS) and Fibromyalgia: A systematic review and three-level meta-analysis, 2021, Barhorst et al

Pain-related post-exertional malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia: A systematic review and three-level meta-analysis


Abstract
Objective
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia (FM) are two debilitating, moderately comorbid illnesses in which chronic musculoskeletal pain symptoms are prevalent. These individuals can experience post-exertional malaise (PEM), a phenomenon where symptom severity is worsened 24hr or longer following physical stress, but the pain-related component of PEM is not well characterized.

Design
Systematic review and meta-analysis

Methods
Case-control studies involving adults with ME/CFS or FM and measuring pain symptoms before and after exposure to a standardized aerobic exercise test were included. Hedges’ d effect sizes were aggregated using random effects models and potential moderators were explored with meta-regression analysis. Results were adjusted for nesting effects using three-level modeling.

Results
Forty-five effects were extracted from 15 studies involving 306 patients and 292 healthy controls. After adjusting for nesting effects, we observed a small-to-moderate effect indicating higher post-exercise pain in patients than controls (Hedges’ d=0.42; 95% CI: 0.16, 0.67). The mean effect was significantly moderated by pain measurement timepoint (b = -0.19, z = -2.57, P = 0.01) such that studies measuring pain 8-72hr post-exercise showed larger effects (d = 0.71, 95% CI = 0.28-1.14) than those measuring pain 0-2hr post-exercise (d = 0.32, 95% CI = 0.10-0.53).

Conclusions
People with ME/CFS and FM experience small-to-moderate increases in pain severity following exercise which confirms pain as a component of PEM and emphasizes its debilitating impact in ME/CFS and FM. Future directions include determining mechanisms of pain-related PEM and developing exercise prescriptions that minimize symptom exacerbation in these illnesses.

https://academic.oup.com/painmedici...93/pm/pnab308/6404604?redirectedFrom=fulltext

 

This is where PESE can remove some confusion. Of course if pain is a symptom of an illness characterized by exacerbation of symptoms that symptom will be exacerbated, it's literally what it means to describe. Just like adding more water to something means it will be more wet. It's literally what it describes.

But it can also lead to confusion that without exertion there are no symptoms, they can only be brought about by exertion, which too many will interpret as "going jogging" or whatever.

That people are still running around in circles because of failure to nail down basic vocabulary is one of the most absurd and inept failures I have ever seen. "The pen is mightier than the sword" doesn't just apply in war, dammit.

 

Taking a ride on a merry-go-round would make my vertigo worse.

 

I can (I have FM) do a one-pound bag of rice bicep curls twice and experience pain the next day as though I had done a whole set (10 reps) of 5 lb barbells. It's so fun.

And then, just to mess with my brain, occasionally I can get away with no pain from the rice curls.

 

@shak8

I wonder if this is the difference between FM pain and ME/CFS pain? I don't experience pain at all, but I have communicated with pwFM and pwME regarding pain, pwFM can get away at times w/o pain after exercise, but pwME did not.

 

My body has multiple sites just ready to kick off strong pain signals if I "overuse" (normal use) the muscles. These sites are the thighs, shins, buttocks area and lower back, all of my back, neck, upper arms, shoulders and anterior chest.

Delayed onset of pain gets me into trouble. Hours later to 24 hrs. later. It's a very fine line of how much I can do that won't push me into a "fibro flare-up" of pain. And much of the time, I just don't know why it got so bad. It can be 5-10 minutes more of walking. It could be walking three days in a row for 25 minutes, or not.

Most troubling is the flare up of pain in my upper back, neck, scalp areas.

As far as I know, FM is sensed in the muscles: extreme stiffness, ache, spasm, burning, sometimes pins and needles. . Responds reasonably well to heat.

I never feel the pain in my joints, per se, from fibro pain. I have no headaches or nausea with the pain. What I always have is nagging upper back and neck pain. I'm forever using heat sacs, pain creams, heating pad, a muscle relaxant.

n=1 on all this.