🧠 Overview
“Pain–Fatigue Type” is a state in which the body and brain become stuck in a continuous loop of “pain–fatigue–stress–insufficient rest,” until every system in the body gradually falls out of balance without the person even realizing it.
It is not just ordinary soreness or simple tiredness, but a condition in which the central nervous system and the immune system over-react to physical and emotional stress, leading to chronic symptoms that are both “subjectively real” and “objectively measurable” at the biological level.
In the early phase, many people may only feel that they “get tired unusually easily” or “have frequent pain without a clear reason.”
But as time passes, the pain becomes more chronic, and the body spends more and more energy trying to cope with it.
The result is: the more tired you are, the more sensitive you become to pain — and the more pain you feel, the more exhausted you become. It turns into a loop that is very difficult to escape.
The brains of people in this state tend to enter a “hyper-alert” mode, or a constant threat-monitoring mode.
The insula and anterior cingulate cortex, which are responsible for processing bodily sensations, are activated so frequently that the brain “remembers” pain as a permanent signal.
At the same time, the reward circuit and dopamine pathways start to down-regulate, leading to a sense of exhaustion and a loss of motivation to do things.
Many people with Pain–Fatigue Type feel confused, wondering whether they “have a physical illness or a mental illness.”
In reality, it is both systems, intertwined in a complex way.
Psychological stress can increase levels of cytokines in the bloodstream, which in turn amplify pain.
Meanwhile, chronic pain pushes the brain to repeatedly release stress chemicals, creating a layered, self-reinforcing loop.
This condition is also frequently associated with comorbid states such as fibromyalgia, chronic fatigue syndrome, migraine, or even depressive disorders.
But the key point is: regardless of what diagnostic label is used, the underlying core is that “the body and brain have been operating beyond their sustainable limits for a prolonged period of time.”
Psychologically, people in this state often feel as if their life energy is being taken away little by little.
Even after a full night’s sleep, they do not feel refreshed, as if their body has never truly recovered.
Eventually, feelings of hopelessness and low self-worth begin to take root and solidify.
Thus, Pain–Fatigue Type is not merely a condition of “having pain,” but a negative learning process in the brain that becomes attached to sensations of pain and exhaustion.
To truly understand this condition, we must look at the physical, psychological, and neurobiological dimensions together — in order to gently unwind this loop layer by layer.
In summary: “Your body is not lying to you — it is trying to tell you that the entire system needs rest, recovery, and a full reset.”
🧩 Core Symptoms
Pain–Fatigue Type is a condition in which the body, brain, and emotions communicate out of sync, with four “core dimensions of symptoms” that interact and combine into a picture of chronic suffering across both body and mind.
1️⃣ Pain – Chronic pain / Unusually heightened pain sensitivity
The pain in this condition does not arise solely from tissue damage, but from the “amplification of pain signals in the brain” (central sensitization).
This means that the brain and spinal cord start to magnify pain sensations beyond what would be expected, so that even minor stimuli are interpreted as threats.
For example:
- Just lifting a small object feels as if the muscles are giving out.
- Simply bending down to pick something up can cause back pain that lasts for hours.
- On some days, it feels as if the entire body is bruised, even though there has been no physical impact.
Brain regions such as the insula, somatosensory cortex, and anterior cingulate cortex (ACC) play key roles in “perceiving–interpreting–remembering” pain.
When these circuits are repeatedly activated, sensitization develops, making pain easier to trigger; and once pain arises, the brain becomes even more sensitive to incoming stimuli.
What makes many people feel pain for a long time is that “the brain learns and stores the pattern of pain,” like saving a file in the nervous system.
So even when the physical cause has resolved (for example, a wound has healed), the brain may still send out “pain” signals.
This is why many patients are misunderstood as “imagining it” or “it’s all in your head,” when in fact, their brains are simply working far too hard.
2️⃣ Fatigue – Deep, biological exhaustion
“Fatigue” in Pain–Fatigue Type is different from “ordinary tiredness.” It is a biological level of exhaustion.
The body’s and brain’s energy systems cannot produce enough energy to match what is being used — as if the battery is never fully charged.
People with this condition often say things like:
- “Even if I sleep all day, I still don’t feel rested,” or
- “Just doing a small amount of work drains me completely.”
The main cause lies in dysregulation of the HPA axis (Hypothalamus–Pituitary–Adrenal).
This system controls the release of cortisol, a hormone related to energy, alertness, and stress regulation.
When this axis is chronically over-activated (due to pain, stress, or lack of proper rest), cortisol secretion becomes abnormal:
for some people it is too high (hyperarousal — constantly wired), for others too low (feeling drained all day).
As a result:
- The body feels like it has to “force itself to stay awake” all the time.
- Muscles do not properly recover after use.
- The brain feels foggy; thinking is slow; attention span is short; it feels as if life energy has leaked away.
This state is also linked to mitochondria, the energy powerhouses of cells.
Chronic inflammation and the release of cytokines impair mitochondrial function.
This leads to “cell-level” fatigue, which does not truly recover no matter how much you rest.
3️⃣ Cognitive & Emotional Drain – Brain fatigue + Emotional downturn
The exhaustion does not only occur in the body; the brain itself becomes “tired”.
When the fronto-striatal circuits and prefrontal cortex are overused, the brain down-regulates parts of its energy usage.
This reduces the capacity for focus, planning, and emotional regulation.
People in this state often feel:
- Mental heaviness, as if there is a fog covering the brain (“brain fog”).
- Thinking more slowly than usual.
- Decisions become harder to make.
- Mood changes quickly; irritability or sadness comes easily.
When the brain can no longer regulate emotions effectively, pain is interpreted as more intense, because the amygdala, the emotional center, sends out stronger danger signals.
Eventually, people start to feel hopeless, believing that any treatment “doesn’t really help,” even though the body is simply still in the process of recovery.
4️⃣ Functional Impairment – Daily life disruption
Pain–Fatigue Type usually does not knock someone down in one blow; instead, it gradually erodes their capacity for everyday life.
For instance:
- They have to take sick days more often due to severe fatigue.
- They avoid traveling or exercising because they fear symptom flare-ups.
- They spend more time on tasks, yet achieve less.
- They constantly plan life around “what if I hurt” or “what if I crash and can’t move.”
Repeated self-limitation like this leads the brain to develop “avoidance learning.”
The body begins to interpret ordinary activities as “threats” → the brain sends “stop” signals even in the absence of real danger.
The more one avoids, the more sensitive the brain becomes to pain (pain sensitization).
Eventually, life becomes a cycle of: pain → fatigue → fear → avoidance → intensified pain.
✅ Diagnostic Criteria
Even though Pain–Fatigue Type is not an official diagnosis in DSM or ICD,
researchers in neuropsychology and pain medicine use this framework to understand people who have “complex chronic pain–fatigue symptoms.”
Below is a detailed conceptual framework used to differentiate this group from those with only temporary pain or fatigue.
1️⃣ Chronic pain or fatigue lasting ≥ 3–6 months
This is the most important condition. Everyone has periods of tiredness, but if the symptoms persist for more than 3 months,
and do not improve even after rest or adequate sleep, it suggests that the body’s energy system is beginning to have system-level problems.
Examples:
- Non-specific muscle or joint pain.
- Migrating pain or a sensation as if the whole body is being squeezed.
- Feeling exhausted even without much physical exertion.
- Needing an unusually long time to “recover” after activities.
2️⃣ Symptoms significantly interfere with daily functioning
Pain and fatigue at this level do more than cause discomfort — they genuinely slow life down.
For example:
- Reduced work performance; needing to rest frequently during the day.
- Avoiding social activities or going out less often.
- Losing the ability to maintain work–life balance.
- Spending a lot of time planning around or compensating for low energy.
The result is a combined erosion of social, economic, and psychological well-being.
3️⃣ Presence of emotional or cognitive symptoms (at least one)
Because the limbic system and prefrontal cortex are directly connected, chronic pain naturally extends into emotional territory.
Examples include:
- Feelings of hopelessness when treatments do not seem to work.
- Feelings of guilt for not being able to work or take care of others as before.
- Health anxiety — persistent fear and worry about one’s physical condition.
- Repetitive, intrusive thoughts such as “my body is permanently broken now.”
Mechanistically, these emotional states intensify the pain–fatigue loop, because stress further activates the HPA axis and the immune system.
4️⃣ Physical examinations do not match the severity of symptoms
This is often where patients are misunderstood by healthcare systems.
Many people have blood tests, joint or muscle exams, or MRI scans that “show nothing abnormal.”
But in reality, their brains are overly sensitive — the pain is not fake.
This condition is known as central sensitization syndrome (CSS),
seen in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, tension headaches, and others.
In CSS, the pain is “real pain originating from the central nervous system,” not imagination.
5️⃣ Symptoms cannot be fully explained by other conditions alone
For example, the symptoms are not solely due to heart disease, endocrine disorders, infections, or depression alone,
but rather arise from a combination of multiple systems — brain, hormones, immune function, and psyche — interfering with each other.
This framework therefore emphasizes multidimensional analysis, instead of viewing it as just one single disease.
For instance, a clinician might find that a patient has mild depression and high pain sensitivity, which together constitute the picture of Pain–Fatigue Type.
💡 Overall picture of these criteria
Pain–Fatigue Type is a chronic multidimensional state
in which physical pain and energy-related fatigue are tightly linked with emotions, thoughts, and the structural/functional state of the brain.
In practice, this framework is used to:
- Understand people who “appear normal on the outside, but are completely drained inside.”
- Guide counseling, treatment planning, and emotional support.
- Distinguish genuine suffering from the dismissive label of “it’s all in your head,” which can create deep psychological wounds.
🧩 In short:
- Core Symptoms are what the body and brain are “shouting out loud” — that the limit has already been exceeded.
- Diagnostic Criteria are tools that help us see that reality — so that a person’s pain and fatigue can be acknowledged as real, exactly as they experience them.
🧬 Subtypes or Specifiers
Within the Pain–Fatigue Type framework, we can divide subtypes for the purposes of writing, teaching, or clinical description:
1️⃣ Inflammatory-Pain Dominant Type
Focus: inflammation of muscles, joints, or the immune system.
- Clear joint and muscle pain.
- Swelling, redness, warmth, or elevated inflammatory markers in blood tests.
- Fatigue arises because the body is using energy to cope with ongoing inflammation.
2️⃣ Central-Sensitization Type
Focus: “over-sensitive nervous system” (central sensitization).
- The central nervous system (brain–spinal cord) amplifies pain signals beyond the actual physical input.
- Pain from mild stimuli that should not normally hurt — for example, even a light touch can feel painful.
- Commonly seen in fibromyalgia and chronic widespread pain.
3️⃣ Cognitive-Fatigue Dominant Type
Here, fatigue is brain-led rather than body-led.
- Using the brain for a short period leads quickly to exhaustion, fogginess, and dizziness.
- Tasks requiring analysis and executive function cause a marked drop in energy.
- People often say, “It feels like my brain’s battery drains way too fast.”
4️⃣ Mood-Linked Pain–Fatigue Type
A loop where pain–fatigue and depressive/anxious mood reinforce each other.
- When depression worsens, pain and fatigue also intensify.
- When pain–fatigue is severe, the person feels even more that life is meaningless.
- Often accompanied by negative thoughts about self and the future.
5️⃣ Sleep-Disrupted Type
Rooted in, or significantly worsened by, disrupted sleep.
- Non-restorative sleep, frequent awakenings, or insomnia.
- Or sleeping for long hours but not feeling rested.
- Poor-quality sleep greatly amplifies both pain and fatigue, often by several fold.
🧠 Brain & Neurobiology
Pain–Fatigue Type is one of the conditions in which the “interface between brain and body” is directly out of sync.
In other words, the body does not just feel pain because of muscles or joints; rather, the brain itself becomes a generator, amplifier, and memory store of pain and fatigue.
Multiple neural circuits are involved — the pain-signaling system, the stress-control system, the reward system, and the immune–brain communication system.
1️⃣ Central Sensitization — the brain amplifies pain signals
Under normal conditions, nociceptors (pain receptors) send information from the site of injury → spinal cord → thalamus → somatosensory cortex,
to evaluate the location and intensity of pain.
In Pain–Fatigue Type, this pathway becomes sensitized, especially at synapses between the spinal cord and thalamus.
What happens is:
- Nerves release excessive neurotransmitters (such as glutamate and substance P).
- NMDA receptors are repeatedly stimulated, creating a “memory of pain.”
- The brain continues to register pain signals even without new stimuli.
Relevant brain regions include:
- Thalamus: the gatekeeper of sensory input (when dysregulated, it lets all signals in).
- Somatosensory Cortex: interprets the location and magnitude of pain.
- Insula: senses changes in the body, such as tension and discomfort.
- Anterior Cingulate Cortex (ACC): interprets pain as “suffering.”
- Amygdala: links pain with fear and stress.
Taken together, the body feels as if “anything can hurt” — touch, movement, or even emotionally-charged thoughts.
2️⃣ HPA Axis Dysregulation — a stress system out of balance
The HPA axis (Hypothalamus–Pituitary–Adrenal) is the core stress and energy-regulation system.
When the body is in pain or under pressure, the hypothalamus releases CRH (Corticotropin-Releasing Hormone) →
this stimulates the pituitary to release ACTH (Adrenocorticotropic Hormone) →
which then signals the adrenal glands to release cortisol to counter inflammation and generate energy.
When this system is used continuously without real recovery — as in chronic pain, chronic stress, or sleep deprivation —
cortisol can no longer maintain a healthy rhythm: in some people it is too high (hyperarousal), in others too low (an adrenal fatigue-like state).
Consequences include:
- Immune dysregulation → chronic low-grade inflammation.
- Fluctuating blood pressure and blood sugar → easy fatigue.
- Disruption of circadian rhythm → shallow, non-restorative sleep.
- Shrinkage of the hippocampus, a region critical for memory.
In the end, pain and fatigue become key signals of a “brain system that is running out of power.”
3️⃣ Dopamine & Reward Circuit Imbalance — a dysregulated reward system
In healthy individuals, when we do something rewarding, the brain releases dopamine to motivate us to repeat that behavior.
In people with chronic pain–fatigue, the brain starts associating everyday activities more with “exhaustion” than “pleasure.”
The mesolimbic pathway — especially the ventral tegmental area (VTA) and nucleus accumbens — reduces dopamine output.
- This leads to:
- “I don’t even want to start anything” (anergia).
- A sense that “nothing is worth the effort.”
- Diminished response to pleasure — food, music, or enjoyable activities no longer feel rewarding.
Reduced dopamine also slows down motor circuits in the basal ganglia,
explaining why people in this state move slowly, tire easily, and think more slowly even in the absence of clear structural disease.
4️⃣ Default Mode Network (DMN) Overactivity & Rumination
The Default Mode Network (DMN) is the network active when we are “doing nothing” — thinking of the past, imagining the future, or reflecting on ourselves.
In those who are in pain and fatigued, this network refuses to switch off.
It repeatedly replays pain, exhaustion, and memories of suffering.
When the DMN is overactive, regions like the medial prefrontal cortex, posterior cingulate cortex (PCC), and precuneus become overly synchronized,
producing a cycle of “rumination → distress → more rumination.”
This layers physical pain and emotional pain on top of each other.
People in this state often say:
“It’s not just my body that hurts — it’s like my brain won’t let me rest at all.”
5️⃣ Immune–Brain Crosstalk — mis-timed communication between the immune system and brain
The immune system and the brain “talk” via signaling molecules known as cytokines,
such as IL-1β, IL-6, and TNF-α, normally released during inflammation or infection.
In Pain–Fatigue Type, the body exists in a state of chronic low-grade inflammation.
These cytokines can enter the brain through the blood–brain barrier, or activate the vagus nerve.
Once inside the brain, they stimulate microglia (the brain’s immune cells) to release further inflammatory substances → intensifying pain and fatigue circuits.
People in this state often feel like they are “chronically unwell” even without actual infection —
as if they have a constant low-grade fever, unexplained exhaustion, and general achiness or chills.
🧩 Summary of the brain in Pain–Fatigue Type
- Insula / ACC = perceive and amplify pain.
- Amygdala / HPA Axis = bind fear to stress responses.
- Prefrontal Cortex / Dopamine System = reduce motivation and energy.
- DMN / PCC = continuously ruminate on pain, fatigue, and hopelessness.
- Immune signaling / Microglia = biologically drive fatigue and pain via inflammation.
Overall, this is not simply a “broken body,” but “a body and brain locked in a permanent survival mode that refuses to switch off.”
⚠️ Causes & Risk Factors
Pain–Fatigue Type does not arise from a single cause; it is “the overlap of multiple systems losing balance simultaneously,” leading to dysfunction of both brain and body.
We can categorize the contributing factors into six major groups:
1️⃣ Genetic & Neurological Predisposition
- Studies show that people with first-degree relatives who have chronic pain (fibromyalgia, migraine, irritable bowel, etc.) have a higher risk than the general population.
- Certain genes, such as COMT, BDNF, and SLC6A4, may influence the metabolism of dopamine and serotonin, which affects pain perception and emotional regulation.
- Some individuals have an autonomic nervous system with a “baseline” that is more reactive than normal,
→ so they tire easily, feel pain more readily, and experience rapid heartbeat even without heavy exertion.
2️⃣ Physical & Medical History
- Muscle, tendon, or joint injuries — accidents, car crashes, surgery, or prolonged physical illness.
- Autoimmune diseases such as lupus, rheumatoid arthritis, multiple sclerosis.
- Chronic infections such as Epstein–Barr virus or long COVID.
- Even after physical illnesses are “cured,” the brain may still “remember” the pain as long-term memory.
3️⃣ Chronic Stress & Burnout
- Accumulated stress from work, relationships, or social pressure.
- When the HPA axis is activated continuously, the brain adapts by shifting into an “energy-saving” mode → persistent fatigue.
- Burnout has striking similarities to Pain–Fatigue Type: emotional exhaustion, cognitive fatigue, and widespread bodily pain without overt structural disease.
Those who work intensely without adequate rest — such as healthcare workers, nurses, caregivers, or people with heavy family responsibilities — are at especially high risk.
4️⃣ Sleep Deprivation & Circadian Rhythm Disruption
- Insufficient sleep, staying up late, waking up too early, or shift work disturb the normal rhythms of cortisol and melatonin.
- Screen use before bed exposes the brain to blue light, suppressing melatonin and preventing the system from “resetting” pain and energy circuits.
- When the body fails to recover through sleep, inflammatory markers such as IL-6 and CRP rise, and the pain–fatigue loop intensifies.
- Some studies report that individuals with sleep fragmentation (non-continuous sleep) have pain sensitivity levels 40–60% higher than before.
5️⃣ Psychological & Cognitive Factors
- Pain catastrophizing: a tendency to interpret pain in the worst possible way (“If it hurts, it must mean my body is collapsing”), which keeps the amygdala continuously activated.
- Self-directed guilt, such as “I’m not good enough,” or “I do less than everyone else.”
- Personality traits like perfectionism or hyper-responsibility increase risk, because such individuals rarely allow their bodies to rest.
- Childhood experiences of neglect or emotional trauma create toxic stress imprints, making the nervous system more sensitive to stress over the long term.
6️⃣ Environmental & Lifestyle Triggers
- A sedentary lifestyle weakens muscles and reduces blood flow, resulting in less oxygen delivered to the brain.
- Over-exercising or pushing the body far beyond its limits is also risky, as it destabilizes mitochondrial function.
- Diets high in sugar, trans fats, caffeine, or alcohol disturb insulin balance and increase inflammation.
- Deficiencies in nutrients such as vitamin D, magnesium, CoQ10, or B-complex slow the nervous system’s recovery.
- Environments with constant noise, harsh lighting, or high pollution (e.g., big cities) chronically trigger sensory overload.
💬 Summary
Pain–Fatigue Type is the result of multiple systems falling out of balance at the same time —
an over-sensitive brain, a dysregulated stress-hormone system, low-grade inflammation in the immune system, and a mind that never truly rests.
When all of these interact, pain and fatigue do not easily go away, even when a person “looks normal” from the outside.
🩶 The brain is not deceiving us — it is trying to protect us from a world in which we have never really given it a chance to rest.
🩺 Treatment & Management
Very important: this section presents broad concepts intended for educational or article-writing purposes.
It is not a set of medical treatment orders.
Anyone with chronic pain–fatigue should always consult a physician for proper evaluation.
1. Medical Assessment
- Investigate and treat possible physical conditions (arthritis, muscle disorders, neurological conditions, immune disorders, etc.).
- Assess mental health, such as depression, anxiety, PTSD, etc.
- Review medications and substances that might be worsening fatigue or pain.
2. Medication (under medical supervision)
- Anti-inflammatory drugs and muscle relaxants (short-term use).
- Certain medications that help with both pain and mood, such as specific antidepressants or anticonvulsants (in cases of fibromyalgia, neuropathic pain, etc.).
- Balancing medications to avoid side effects like excessive drowsiness or increased fatigue.
3. Physical Therapy and Movement
- Exercise programs with gradual increase in intensity (graded exercise / graded activity).
- Gentle stretching, yoga, Pilates, slow walking in the initial phase.
- Emphasis on “small, consistent movement” rather than “pushing hard all at once.”
4. Psychological Therapies
- CBT (Cognitive Behavioral Therapy) to address thoughts related to pain and fatigue.
- ACT (Acceptance and Commitment Therapy) to learn how to live with symptoms without letting them define one’s entire identity.
- Stress-management therapies, progressive muscle relaxation, and breathing exercises.
5. Sleep and Circadian Rhythm Management
- Sleep hygiene: avoid screens before bed; maintain consistent sleep–wake times.
- Reduce caffeine intake in the afternoon and evening.
- Plan schedules that include real rest periods — not just “breaks” spent scrolling on a phone.
6. Self-Management
- Pacing: break tasks into smaller segments with rests in between, instead of working until completely exhausted and resting only afterwards.
- Activity diary: record activities and symptoms to identify personal patterns.
- Learn one’s own energy budget, then prioritize tasks and activities accordingly.
📝 Notes (Important Considerations)
- Pain–Fatigue Type is a descriptive framework, not an official medical diagnosis in DSM/ICD.
- The goal is to help people who experience “pain–fatigue–burnout” feel that:
“What I’m going through has a bigger picture and neurobiological logic.
It’s not laziness or weakness.”
- Effective care often requires a multidisciplinary team: general practitioners/rehabilitation physicians, physical therapists, psychiatrists, psychologists, nutritionists, etc.
- There is no single “universal cure.” Each person must experiment, adjust, and discover their own balance.
📚 Reference (Research & Reviews)
Apkarian, A. V., Baliki, M. N., & Geha, P. Y. (2009). Towards a theory of chronic pain. Progress in Neurobiology, 87(2), 81–97.
Clauw, D. J. (2014). Fibromyalgia: A clinical review. JAMA, 311(15), 1547–1555.
Häuser, W., Ablin, J., Fitzcharles, M. A., Littlejohn, G., Luciano, J. V., Usui, C., & Walitt, B. (2015). Fibromyalgia. Nature Reviews Disease Primers, 1, 15022.
Nijs, J., Meeus, M., Van Oosterwijck, J., Ickmans, K., Moorkens, G., Hans, G., & De Clerck, L. S. (2012). In the mind or in the brain? Scientific evidence for central sensitization in chronic fatigue syndrome. European Journal of Clinical Investigation, 42(2), 203–212.
Harte, S. E., Harris, R. E., & Clauw, D. J. (2018). The neurobiology of central sensitization. Journal of Applied Biobehavioral Research, 23(2), e12137.
Dantzer, R., O’Connor, J. C., Freund, G. G., Johnson, R. W., & Kelley, K. W. (2008). From inflammation to sickness and depression: When the immune system subjugates the brain. Nature Reviews Neuroscience, 9(1), 46–56.
Miller, A. H., & Raison, C. L. (2016). The role of inflammation in depression: From evolutionary imperative to modern treatment target. Nature Reviews Immunology, 16(1), 22–34.
Brosschot, J. F., Verkuil, B., & Thayer, J. F. (2017). Exposed to events that never happen: Generalized unsafety, the default stress response, and prolonged autonomic activity. Neuroscience & Biobehavioral Reviews, 74, 287–296.
Loggia, M. L., et al. (2015). Disrupted brain circuitry for pain-related reward/punishment in fibromyalgia. Arthritis & Rheumatology, 67(9), 2557–2567.
Kutch, J. J., & Apkarian, A. V. (2015). Chronic pain: A maladaptive learning disorder. Neuron, 87(5), 1070–1082.
McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiological Reviews, 87(3), 873–904.
Meeus, M., & Nijs, J. (2007). Central sensitization: A biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clinical Rheumatology, 26(4), 465–473.
Komaroff, A. L. (2019). Advances in understanding the pathophysiology of chronic fatigue syndrome. JAMA, 322(6), 499–500.
Slavich, G. M., & Irwin, M. R. (2014). From stress to inflammation and major depressive disorder: A social signal transduction theory of depression. Psychological Bulletin, 140(3), 774–815.
Tracey, I., & Mantyh, P. W. (2007). The cerebral signature for pain perception and its modulation. Neuron, 55(3), 377–391.
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