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Background Methods Results Conclusion Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM) are comorbid disorders with overlapping symptoms. Research highlights autonomic dysfunction compared to healthy individuals, particularly involving the sympathetic branch. While past reviews focused on neurophysiological assessments, this systematic review summarises biological adrenergic markers, offering deeper insights into the observed sympathetic dysfunction in ME/CFS and FM aiming to identify targetable pathophysiological mechanisms.A systematic search was performed on PubMed, Web of Science, Embase and Scopus. Studies investigating peripheral biological markers of adrenergic function in patients with ME/CFS or FM compared to healthy controls at baseline were included. Meta‐analyses were performed using R statistical software.This meta‐analysis of 37 studies, encompassing 543 ME/CFS patients and 651 FM patients, compared with 747 and 447 healthy controls, respectively, revealed elevated adrenaline (SMD = .49 [.31–.67]; Z = 5.29, p < .01) and β1 adrenergic receptor expression (SMD = .79 [.06–1.52]; Z = 2.13; p = .03) in blood of ME/CFS patients at rest. Additionally, patients with ME/CFS had a greater increase in the expression of α2A adrenergic receptor (AR, SMD = .57 [.18–.97]; Z = 2.85, p < .01), β2 AR (SMD = .41 [.02–.81]; Z = 2.04; p = .04) and COMT (SMD = .42 [.03–.81]; Z = 2.11; p = .03) after exercise and an increased response of noradrenaline to an orthostatic test (SMD = .11 [−.47 to −.70]; Z = 2.10; p = .04), both found in blood. FM patients showed no significant differences at baseline but exhibited a diminished adrenaline response to exercise (SMD = −.79 [−1.27 to −.30]; Z = −3.14; p < .01).This systematic review and meta‐analysis revealed adrenergic dysfunction mainly in patients with ME/CFS. Higher baseline adrenaline levels and atypical responses to exercise in ME/CFS indicate that sympathetic dysfunction, underscored by adrenergic abnormalities, is more involved in the pathophysiology of ME/CFS rather than FM. [ABSTRACT FROM AUTHOR]

Background: Hypermobility Spectrum Disorder (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS) are two overlapping heritable connective tissue disorders characterized by joint hypermobility, chronic pain, impaired body perception, and musculoskeletal symptoms. Central sensitization has been proposed as a plausible explanation for symptoms like widespread pain, fatigue, mood disorders, and sleep disturbances in patients with HSD/hEDS., Objective: The aim of this study was to investigate signs of central sensitization, including exercise-induced hypoalgesia (EIH), and fatigue severity in adolescents with HSD/hEDS., Methods: In this prospective, experimental, case-control study, thirty-seven adolescents with HSD/hEDS and 47 healthy adolescents (all aged 13-17 years) were included. Pressure pain thresholds (PPTs) were measured at four muscle groups using a pressure algometer. EIH was evaluated by measuring PPTs on two muscle groups immediately after an exercise test on a bicycle ergometer. Participants also completed questionnaires on fatigue and cognitive/emotional factors., Results: The study demonstrated significantly lower PPTs in four different muscle groups in adolescents with HSD/hEDS compared to the healthy control group. Both groups achieved a significantly higher PPTs after exercise in the muscle involved in the activity. Adolescents with HSD/hEDS reported higher fatigue levels and more cognitive/emotional difficulties than the control group., Conclusion: Adolescents with HSD/hEDS showed generalized hyperalgesia measured through PPTs at different body sites. EIH was partly affected in adolescents with HSD/hEDS, presenting as unchanged pain sensitivity in the remote muscle. Pain should be considered as a phenomenon that is influenced by different biopsychosocial factors, including possible central sensitization, which increase its complexity., Significance Statement: This study breaks new ground by showing signs of central sensitization, including diminished EIH, in adolescents with HSD or hEDS. Given that exercise is a key element in pain management, these findings offer valuable insights when developing treatment plans for adolescents with HSD or hEDS., (© 2024 The Author(s). European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)

A variety of factors are associated with the development and maintenance of chronic pain in children. Identifying modifiable factors associated with pediatric chronic pain is important to use them as target outcomes in the development and evaluation of interventions for the prevention and management of chronic pain. This study aimed to reach expert consensus on factors associated with pediatric chronic pain and their modifiability and population-level effect. Pediatric pain experts were questioned using a web-based two-round modified Delphi method. Two rounds of questions with Likert scaling were used to identify influencing factors (Round 1) and to reach consensus on each factor (Round 2) in terms of: 1) strength of association with chronic pain in children; 2) modifiability; and 3) population-level effect. An inductive approach was used to derive categories (ranging from 'very low' to 'very high') and subcategories (ranging from 'low' to 'high'). In total, 48 experts from 14 different countries completed Round 1, and 31 completed Round 2. A list of 47 factors was considered to be associated with pediatric chronic pain. Four factors (physical activity (PA), sedentary behavior (SB), pain-related school absence, and pain concept/knowledge of the child) were considered highly modifiable and three factors having a high population-level effect (PA, SB, and the child's depressive or negative emotional feelings). Expert consensus was established about modifiable and population-level factors associated with pediatric chronic pain through this web-based modified Delphi study, guiding target outcomes for its prevention and management. PERSPECTIVE: This article presents the results of a modified Delphi study with pediatric pain experts to gain consensus on factors associated with pediatric chronic pain. Relationship strength, modifiability, and population-level effect of associated factors were rated to identify areas of research priority and interventions aiming to reduce the development and maintenance of chronic pain in children., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare. Kelly Ickmans and Emma Rheel developed a pain science education board game for children (PNE4Kids), but the royalties are collected by Vrije Universiteit Brussel, Brussels, Belgium., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Pain Neuroscience Education (PNE) is a commonly used technique applied by physical therapists in the rehabilitation of chronic pain., Objective: The aim of this study was to culturally adapt an existing PNE for children with chronic pain (PNE4Kids) to Turkish children with chronic pain (PNE4Kids-Turkish)., Methods: A three-round modified Delphi-study was conducted between September 2023 and February 2024. Experts completed questionnaire with 5 items to elicit demographic data and 16 closed and 7 open-ended questions to assess relevance of information, feasibility of stories, visual information, and clarity of message in the 4 main areas of 'normal pain biology', 'pain modulation', 'chronic pain, adaptations, central sensitization', and 'the application and implications of PNE4Kids. MAXQDA software was used for qualitative analysis of open-ended questions. A total of 38 experts (mean age: 36.6 ± 9.05 years, 6 male, 32 female) were recruited for this study., Results: The results of the first round indicated that 84-100 % of Delphi experts strongly agreed or agreed on the relevance of information, feasibility of stories, visual information, and clarity of message in respect of the 4 main areas. During second and third round, an acceptable degree of agreement with clinical usefulness of PNE4Kids-Turkish materials was obtained., Conclusions: PNE4Kids was culturally adapted for Turkish children suffering from chronic pain. The findings of this study mainly highlight the viewpoints of the experts., Implication to Practice: This is the first study to have developed and culturally adapted the PNE4Kids for Turkish children with chronic pain. The PNE4Kids-Turkish is crucial, valuable, helpful, and understandable for Turkish children with chronic pain. In addition, the PNE4Kids-Turkish has the potential to close the gap in research and clinical areas for Turkish children with chronic pain., Competing Interests: Declaration of competing interest The authors report there are no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)