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{{Image frame|caption=1-Muscles 2-Joints 3-Headaches 4-Lymph nodes<br >5-Abdominal 6-Sore throat 7-Eyes 8-Chest pain<br> '''Data from: Institute of Medicine 2015 (CDC, Jason et al. 2013b)'''|content={{Graph:Chart|width=280|padding=5,5,5,50|height=auto|type=rect|xAxisTitle=Type of pain|yAxisTitle=%|legend=Legend|x=1,2,3,4,5,6,7,8|y1=75.5,59,52,38,32,26.5,23,15|y2=10,12,7,0,0,1,0,0|fontSize=200%|y1Title=ME/CFS|y2Title=Healthy people|colors={{MEActionRed}},{{MEActionBlue}}|Title=Types of pain|showValues=true}} }} '''Pain''' in medical diagnosis is regarded as a symptom of an underlying condition. == Pain in ME/CFS == Pain occurs in a wide range of forms in [[ME/CFS]] and is typically [[chronic pain|chronic]]. These include: *[[abdominal pain]] (stomach pain) *[[aching pain]] *[[arthralgia]] (joint pain) *[[chest pain]] *[[eye pain]] associated with cervical muscle tension *[[flu-like symptoms|flu-like pain and discomfort]] *[[headache]]s including sinus headaches, [[tension-type headache]]s and [[migraine]]s *generalized [[hyperalgesia]] *[[swollen lymph node|lymph node tenderness]] *[[lowered pain threshold]] or chronic, widespread [[allodynia]] *[[muscle spasm]]s *[[muscle-tendon junction pain]] *[[myalgia]] (muscle pain) *[[myofascial pain]] *[[nerve pain]] (neuropathic pain) including [[burning pain]], [[shooting pain]] and [[stabbing pain]]s *[[pins and needles]] *positive [[fibromyalgia tender points]] occur in most people with ME/CFS *[[peripheral neuropathy|peripheral neuropathies]] *[[radiating pain]] *[[sore throat]] *pain is typically widespread, migratory, and fluctuates<ref name="ICC2011primer" /><ref name="fukuda1994">{{Cite journal | last = Fukuda | first = K. | authorlink = Keiji Fukuda | last2 = Straus | first2 = S.E. | authorlink2=Stephen Straus | last3 = Hickie | first3 = I. | authorlink3 =Ian Hickie | last4 = Sharpe | first4 = M.C. | authorlink4 = Michael Sharpe | last5 = Dobbins | first5 = J.G. | authorlink5=James Dobbins | last6 = Komaroff | first6 = A. | authorlink6 = Anthony Komaroff | date = 1994-12-15| title = The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group | url =https://www.researchgate.net/profile/Michael_Sharpe2/publication/247808895_The_Chronic_Fatigue_Syndrome_A_Comprehensive_Approach_to_Its_Definition_and_Study/links/0c96053201643bfc4b000000/The-Chronic-Fatigue-Syndrome-A-Comprehensive-Approach-to-Its-Definition-and-Study.pdf|journal=Annals of Internal Medicine|volume=121|issue=12 | pages = 953–959|issn=0003-4819|pmid=7978722|via=|publisher=American College of Physicians}}</ref> Pain can also occur as a consequence of commonly comorbid illnesses such as [[migraine]], [[myofascial pain syndrome]] (MPS), [[temporomandibular joint syndrome]] (TMJ), [[interstitial cystitis]], [[Raynaud's phenomenon]], [[irritable bowel syndrome |IBS]], or from [[fibromyalgia]], which is considered an overlapping syndrome.<ref name="ICC2011primer" /><ref name="canadianconsensus-CCC" /> == Pain in fibromyalgia == Researchers believe that [[fibromyalgia]] (FM) amplifies painful sensations by affecting the way your [[brain]] processes pain signals.<ref name=":0">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780| title = Fibromyalgia - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2019-05-03}}</ref> Pain in fibromyalgia is commonly referred to as '''chronic widespread pain''' (CWP) that is otherwise '''unexplained''', meaning not caused by another medical condition. Fibromyalgia pain is assessed by a combination of location and frequency: pain must be present at least weekly in each pain location that is counted. Besides pain, additional fibromyalgia symptoms are also required.<ref name="ACR2010" /> ===Widespread Pain Index === Before 2010, a tender point examination was needed to that assessed pain on pressure, but this has now been replaced by the more accurate Widespread Pain Index (WPI). The WPI scores pain in 19 locations: * Shoulder girdle - left and right * Hip (buttock, trochanter) - left and right * Jaw - left and right * Upper arm - left and right * Upper leg - left and right * Lower arm - left and right * Lower leg - left and right * Upper back * Lower back * Chest * Neck * Abdomen Pain in fibromyalgia must not be explained by another medical condition, and must persist for at least three months, and exist in addition to a combination of other symptoms.<ref name="ACR2010">{{Cite journal|url=https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf| title = American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia | last = Wolfe | first = Frederick | date = May 2010|volume =62 | issue = 5 | pages = 600–610| doi = 10.1002/acr.20140|type=PDF|archive-url=|archive-date=|access-date= | authorlink = | last2 = Clauw | first2 = Daniel | authorlink2 = |journal=Arthritis Care & Research | last3 = Fitzcharles | first3 = Mary-Ann | first4 = Don | last5 = Katz | last4 = Goldenberg | first5 = Robert | last6 = Mease | first6 = Philip | last7 = Russel | first7 = Anthony | last8 = Russel | first8 = I. Jon | first9 = John | last9 = Winfield | first10 = Muhammad | last10 = Yunus | authorlink10 = Muhammad Yunus}}</ref> {{See also|Fibromyalgia|Fibromyalgia symptoms||||}} ===Pain types=== Types of pain commonly reported in fibromyalgia include: [[irritable bowel syndrome]], [[paresis|muscle weakness]], [[headache]], [[paresthesia|numbness/tingling]], [[heartburn]], [[painful bladder syndrome|painful urination]], and bladder spasms *[[allodynia]] *[[Arthralgia|joint pain]], which may be worsened by [[weight gain]] causing stress on joints *[[hyperalgesia]] *[[muscle spasm]]s *[[myalgia]] (muscle pain) *[[nerve pain]] (neuropathic pain) Many people with fibromyalgia will have other painful comorbid conditions such as: * tension [[Headache|headaches]] and [[Migraine|migraines]] * [[Temporomandibular joint disorder|temporomandibular joint disorders]] (TMJ) * [[rheumatoid arthritis]] (RA) * [[Systemic lupus erythematosus|lupus]] * [[Sjögren's syndrome]] * [[ankylosing spondylitis]] * [[irritable bowel syndrome]] (IBS) * [[menstrual cycle]] cramps and [[interstitial cystitis]] <ref name="ACR2010" /><ref name=":0" /><ref>{{Cite web|url=https://www.health.com/health/gallery/0,,20520705,00.html| title = 7 Conditions Linked to Fibromyalgia | last = Mann | first = Denise | authorlink= | date = Sep 7, 2011 | website = Health.com|language=en|archive-url=|archive-date=|url-status=|access-date=2019-05-03}}</ref><ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14= John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24= Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012 | isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref> ==Symptom recognition== *In the [[Canadian Consensus Criteria]], pain is a required criteria for diagnosis. It requires that "there is a significant degree of myalgia. Pain can be experienced in the muscles, and/or joints, and is often widespread and migratory in nature. Often there are significant headaches of new type, pattern or severity."<ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 =Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02 | url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf }}</ref><ref>[http://sacfs.asn.au/download/consensus_overview_me_cfs.pdf ''A Clinical Case Definition and Guidelines for Medical Practitioners: An Overview of the Canadian Consensus Document''] (2005).</ref>{{Rp|8}} Pain is an optional neurological criteria in the [[International Consensus Criteria]], with many different types of pain recognized.<ref name="ICC2011primer" /> The older [[Fukuda criteria]] for [[chronic fatigue syndrome]] (1994) recognized [[sore throat]], [[swollen lymph node|tender cervical or axillary lymp nodes]], [[headache]]s and other types of pain but did not require them for diagnosis.<ref name="fukuda1994" /> ===Recording pain=== The primer for the [[International Consensus Criteria]] for [[myalgic encephalomyelitis|ME]] includes a pain chart and the [[visual-analogue pain scale]].<ref name="ICC2011primer" /> ==Notable studies== ==Learn more== ==See also== *[[Analgesics|Pain relief (analgesics)]] *[[Chronic pain]] ==References== {{Reflist}} [[Category:Signs and symptoms]] [[Category:Pain signs and symptoms]]
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