Psychological Medicine

Original Articles

Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial

J. H. Bourkea1 c1, A. L. Johnsona2a3, M. Sharpea4, T. Chaldera5 and P. D. Whitea1

a1 Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK

a2 MRC Biostatistics Unit, University of Cambridge Institute of Public Health

a3 MRC Clinical Trials Unit, London, UK

a4 Department of Psychiatry, University of Oxford, Oxford, UK

a5 Academic Department of Psychological Medicine, King's College London, UK


Background Pain is a common symptom of chronic fatigue syndrome (CFS). We investigated the effects of the treatments used in the PACE trial [cognitive behavioural therapy (CBT), graded exercise therapy (GET), adaptive pacing therapy (APT) and specialist medical care (SMC)] on pain in CFS.

Method We compared pain outcomes including individual painful symptoms, taken from the CDC criteria for CFS and co-morbid fibromyalgia. We modelled outcomes adjusting for baseline variables with multiple linear regression.

Results Significantly less frequent muscle pain was reported by patients following treatment with CBT compared to SMC (mean difference = 0.38 unit change in frequency, p = 0.02), GET versus SMC (0.42, p = 0.01) and GET versus APT (0.37, p = 0.01). Significantly less joint pain was reported following CBT versus APT (0.35, p = 0.02) and GET versus APT (0.36, p = 0.02). Co-morbid fibromyalgia was less frequent following GET versus SMC (0.03, p = 0.03). The effect sizes of these differences varied between 0.25 and 0.31 for muscle pain and 0.24 and 0.26 for joint pain. Treatment effects on pain were independent of ‘change in fatigue’.

Conclusions CBT and GET were more effective in reducing the frequency of both muscle and joint pain than APT and SMC. When compared to SMC, GET also reduced the frequency of co-morbid fibromyalgia; the size of this effect on pain was small.

(Received May 31 2013)

(Revised August 06 2013)

(Accepted August 09 2013)

(Online publication August 23 2013)

Key words

  • Adaptive pacing therapy (APT);
  • chronic fatigue syndrome (CFS);
  • chronic pain;
  • cognitive behavioural therapy (CBT);
  • fibromyalgia;
  • graded exercise therapy (GET);
  • PACE trial;
  • rehabilitation