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Central sensitization
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=== Endogenous pain inhibition after exercise === Another way to induce endogenous inhibition is to exercise.Β When healthy people exercise, their brain produces endorphins that increase pain thresholds. In some chronic pain patients like fibromyalgia and whiplash associated disorders, this endogenous pain inhibition response is defect and pain thresholds decrease shortly after exercise (i.e. they experience more pain while they should be feeling less). In 2004 Whiteside et al. first showed this defect in ME/CFS patients, though their study only involved 5 patients.<ref>{{Cite journal | last = Whiteside | first = Alan | last2 = Hansen | first2 = Stig | last3 = Chaudhuri | first3 = Abhijit | date = Jun 2004 | title = Exercise lowers pain threshold in chronic fatigue syndrome | url =http://dx.doi.org/10.1016/j.pain.2004.02.029 | journal = Pain | volume = 109 | issue = 3 | pages = 497β499|doi=10.1016/j.pain.2004.02.029|issn=0304-3959}}</ref> The Pain in Motion group confirmed these results in two of their studies.<ref>{{Cite journal | last = Meeus | first = M | last2 = Roussel | first2 = NA | last3 = Truijen | first3 = S | date = 2010 | title=Reduced pressure pain thresholds in response to exercise in chronic fatigue syndrome but not in chronic low back pain: An experimental study | url = http://dx.doi.org/10.2340/16501977-0595 | journal = Journal of Rehabilitation Medicine | volume = 42 | issue = 9 | pages = 884β890|doi=10.2340/16501977-0595|issn=1650-1977|quote= | authorlink = Mira Meeus|via=}}</ref><ref>{{Cite journal | last = Van Oosterwijck | first = J. | last2 = Nijs | first2 = J. | last3 = Meeus | first3 = M. | last4 = Lefever | first4 = I. | last5 = Huybrechts | first5 = L. | last6 = Lambrecht | first6 = L. | last7 = Paul | first7 = L. | date = 2010-03-03 | title = Pain inhibition and postexertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: An experimental study | url = http://dx.doi.org/10.1111/j.1365-2796.2010.02228.x | journal = Journal of Internal Medicine | volume = 268 | issue = 3 | pages = 265β278|doi=10.1111/j.1365-2796.2010.02228.x|issn=0954-6820|quote= | authorlink = Jessica Van Oosterwijck | author-link2 = Jo Nijs | author-link3 = Mira Meeus | author-link4 = | author-link5 = |via=}}</ref> While pain thresholds increased in normal controls they decreased in the ME/CFS patient group. As a caveat, one must note that these studies only included ME/CFS patients that were suffering from chronic pain while comorbid fibromyalgia (FM) was not assessed. It remains unclear if these results will also hold true in ME/CFS patients that do not have comorbid FM.<ref name=":14">{{Cite journal | last = Yunus | first = Muhammad | date = Jul 2, 2015 | title = Editorial Review (Thematic Issue: An Update on Central Sensitivity Syndromes and the Issues of Nosology and Psychobiology) | url = http://dx.doi.org/10.2174/157339711102150702112236 | journal = Current Rheumatology Reviews | volume = 11 | issue = 2 | pages = 70β85|doi=10.2174/157339711102150702112236|issn=1573-3971|quote= | authorlink = Muhammad Yunus|via=}}</ref>
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