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Jo Nijs
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=== Endogenous pain inhibition after exercise === Another way to induce endogenous inhibition is to exercise. When healthy people exercise, their brain induces the production of endorphins that increase pain thresholds. In some chronic pain patients like fibromyalgia and whiplash associated disorders, this endogenous pain inhibition is defective and pain thresholds decrease shortly after exercise (i.e. they experience more pain while they should be feeling less). In 2004, Whiteside et al.<ref>Whiteside A, Hansen S, Chaudhuri A. Exercise lowers pain threshold in chronic fatigue syndrome. Pain. 2004 Jun;109(3):497-9.</ref> first showed this defect in ME/CFS patients, though their study only involved five patients. The Pain in Motion group of Nijs and colleagues confirmed these results in two of their studies.<ref name="Threshold2010" /><ref name="Oosterwijck2010" /> While pain thresholds increased in normal controls, they decreased in the ME/CFS patient group. These studies however, only included ME/CFS that were suffering from chronic pain.<ref name="NijsMind2012" /> It therefore remains uncertain whether similar results will also show up in ME/CFS patients that do not have comorbid FM.<ref>Yunus MB. Editorial review: an update on central sensitivity syndromes and the issues of nosology and psychobiology. Curr Rheumatol Rev. 2015;11(2):70-85.</ref>
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