{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:05:10Z","timestamp":1791975910836,"version":"4.4.0"},"reference-count":70,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T00:00:00Z","timestamp":1634688000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Career Development","award":["IK2 CX001679"],"award-info":[{"award-number":["IK2 CX001679"]}]},{"name":"United States"},{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Clinical Sciences Research and Development","award":["CSR&D"],"award-info":[{"award-number":["CSR&D"]}]},{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Myalgic encephalomyelitis\u00a0\/ 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 in which symptom severity is worsened for 24\u2009hours or longer after physical stress, but the pain-related component of PEM is not well characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Case\u2013control 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\u2019 d effect sizes were aggregated with random-effects models, and potential moderators were explored with meta-regression analysis. Results were adjusted for nesting effects with three-level modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 in controls (Hedges\u2019 d\u2009=\u20090.42; 95% confidence interval [CI]: 0.16\u20130.67). The mean effect was significantly moderated by pain measurement time point (b\u2009=\u2009\u20130.19, z\u2009=\u2009\u20132.57, P\u2009=\u20090.01), such that studies measuring pain 8\u201372 hours after exercise showed larger effects (d\u2009=\u20090.71, 95% CI\u2009=\u20090.28\u20131.14) than did those measuring pain 0\u20132 hours after exercise (d\u2009=\u20090.32, 95% CI\u2009=\u20090.10\u20130.53).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>People with ME\/CFS and FM experience small to moderate increases in pain severity after 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/pm\/pnab308","type":"journal-article","created":{"date-parts":[[2021,10,16]],"date-time":"2021-10-16T12:24:53Z","timestamp":1634387093000},"page":"1144-1157","source":"Crossref","is-referenced-by-count":41,"title":["Pain-Related Post-Exertional Malaise in Myalgic Encephalomyelitis\u00a0\/ Chronic Fatigue Syndrome (ME\/CFS) and Fibromyalgia: A Systematic Review and Three-Level Meta-Analysis"],"prefix":"10.1093","volume":"23","author":[{"given":"Ellen E","family":"Barhorst","sequence":"first","affiliation":[{"name":"Office of Research and Development, William S. Middleton Memorial Veterans Hospital , Madison, Wisconsin, USA"},{"name":"School of Medicine, Saint Louis University , St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8825-3763","authenticated-orcid":false,"given":"Alexander E","family":"Boruch","sequence":"additional","affiliation":[{"name":"Office of Research and Development, William S. Middleton Memorial Veterans Hospital , Madison, Wisconsin, USA"},{"name":"Department of Kinesiology, University of Wisconsin-Madison , Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3992-4820","authenticated-orcid":false,"given":"Dane B","family":"Cook","sequence":"additional","affiliation":[{"name":"Office of Research and Development, William S. Middleton Memorial Veterans Hospital , Madison, Wisconsin, USA"},{"name":"Department of Kinesiology, University of Wisconsin-Madison , Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1581-3210","authenticated-orcid":false,"given":"Jacob B","family":"Lindheimer","sequence":"additional","affiliation":[{"name":"Office of Research and Development, William S. 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