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Central sensitization
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=== Pain thresholds and hyperalgesia === Various quantitative sensory tests (QST) can be used to evaluate if the CNS overreacts to stimuli and the presence of CS is to be suspected.<ref>{{Cite journal | last = Staud | first = Roland | date = May 2012 | title = Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions |url =http://dx.doi.org/10.1586/ern.12.41 | journal = Expert Review of Neurotherapeutics | volume = 12 | issue = 5 | pages = 577–585|doi=10.1586/ern.12.41|issn=1473-7175|quote= | authorlink = Roland Staud|via=}}</ref> One method involves measuring pain thresholds all over the body with an algometer. The Belgian Pain in Motion research group tested this in 30 ME/CFS who suffered from chronic pain. Pain pressure thresholds were significantly lower compared to those of the control group, also when pain-free areas of the body were tested (secondary hyperalgesia).<ref>{{Cite journal | last = Meeus | first = Mira | last2 = Nijs | first2 = Jo | last3 = Huybrechts | first3 = Sven | last4 = Truijen | first4 = Steven | date = 2010-01-14 | title = Evidence for generalized hyperalgesia in chronic fatigue syndrome: a case control study | url = http://dx.doi.org/10.1007/s10067-009-1339-0 | journal = Clinical Rheumatology | volume = 29 | issue = 4 | pages = 393–398|doi=10.1007/s10067-009-1339-0|issn=0770-3198|quote= | authorlink = Mira Meeus | author-link2 = Jo Nijs|via=}}</ref> In an additional study it was shown that ME/CFS patients experienced more pain following heat stimuli.<ref name=":6">{{Cite journal | last = Meeus | first = Mira | last2 = Nijs | first2 = Jo | last3 = Van de Wauwer | first3 = Naomi | last4 = Toeback | first4 = Linda | last5 = Truijen | first5 = Steven | date = Oct 2008 | title = Diffuse noxious inhibitory control is delayed in chronic fatigue syndrome: An experimental study | url = http://dx.doi.org/10.1016/j.pain.2008.05.018 | journal = Pain | volume = 139 | issue = 2 | pages = 439–448|doi=10.1016/j.pain.2008.05.018|issn=0304-3959|quote= | authorlink = Mira Meeus | author-link2 = Jo Nijs|via=}}</ref> In a large Norwegian study involving 120 adolescent with ME/CFS, pain pressure thresholds were significantly lower in patients compared to healthy controls.<ref>{{Cite journal | last = Winger | first = Anette | last2 = Kvarstein | first2 = Gunnvald | last3 = Wyller | first3 = Vegard Bruun | author-link3 = Vegard Bruun Wyller | last4 = Sulheim | first4 = Dag | last5 = Fagermoen | first5 = Even | last6 = Småstuen | first6 = Milada Cvancarova | last7 = Helseth | first7 = Sølvi | date = Oct 2014 | title = Pain and pressure pain thresholds in adolescents with chronic fatigue syndrome and healthy controls: a cross-sectional study | url = http://dx.doi.org/10.1136/bmjopen-2014-005920 | journal = BMJ Open | volume = 4 | issue = 10| pages = e005920|doi=10.1136/bmjopen-2014-005920|issn=2044-6055}}</ref> Other studies yielded conflicting results. Using cold pressor tests, Schmaling et al. did not find any differences in pain thresholds between ME/CFS patients and healthy controls.<ref>{{Cite journal | last = Schmaling | first = Karen B. | last2 = Hamilos | first2 = Daniel L. | last3 = Diclementi | first3 = Jeannie D. | last4 = Jones | first4 = James F. | date = Jan 1998 | title = Pain Perception in Chronic Fatigue Syndrome | url =http://dx.doi.org/10.1300/j092v04n03_03 | journal = Journal of Chronic Fatigue Syndrome | volume = 4 | issue = 3 | pages = 13–22|doi=10.1300/j092v04n03_03|issn=1057-3321}}</ref> The same finding was reported by Buchwald and colleagues in a study involving 15 twin pairs discordant for [[Chronic fatigue syndrome|CFS]].<ref>{{Cite journal | last = Ullrich | first = Philip M. | last2 = Afari | first2 = Niloofar | last3 = Jacobsen | first3 = Clemma | last4 = Goldberg | first4 = Jack | last5 = Buchwald | first5 = Dedra | date = 2007-02-07 | title = Cold Pressor Pain Sensitivity in Monozygotic Twins Discordant for Chronic Fatigue Syndrome | url =http://dx.doi.org/10.1111/j.1526-4637.2007.00277.x | journal = Pain Medicine | volume = 0 | issue = 0 | pages = 070207140827002–???|doi=10.1111/j.1526-4637.2007.00277.x|issn=1526-2375|quote= | author-link3 = | author-link4 = | author-link5 = Dedra Buchwald|via=}}</ref> An Italian group of the D’Annuzio University of Chieti found pain thresholds in the skin and subcutis to be normal in ME/CFS.<ref>{{Cite journal | last = Vecchiet | first = Leonardo | last2 = Montanari | first2 = Giuseppe | last3 = Pizzigallo | first3 = Eligio | last4 = Iezzi | first4 = Sabina | last5 = de Bigontina | first5 = Paolo | last6 = Dragani | first6 = Luca | last7 = Vecchiet | first7 = Jacopo | last8 = Giamberardino | first8 = Maria Adele | date = Apr 1996 | title = Sensory characterization of somatic parietal tissues in humans with chronic fatigue syndrome | url =http://dx.doi.org/10.1016/0304-3940(96)12559-3 | journal = Neuroscience Letters | volume = 208 | issue = 2 | pages = 117–120|doi=10.1016/0304-3940(96)12559-3|issn=0304-3940}}</ref> They did however find hyperalgesia in the muscles of these patients. Because a number of “anatomical muscle alterations” were discovered, the authors speculated the hyperalgesia to be caused by peripheral instead of central mechanisms.
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