Fatigue: An Overview of Chronic Fatigue and Recommendations for Future Research

This study investigated significant others’ behavior associated with fatigue, pain, and mental health outcomes among 68 individuals with chronic fatigue (43% also had fibromyalgia) over 18 months. More negative significant others’ responses were associated with more pain, poorer physical and mental health, and more fatigue-related symptoms over time. More fibromyalgia tender points covaried with more solicitous significant others’ responses over time. Better mental health covaried with more distracting significant others’ responses over time. The results are discussed in terms of theoretical models of the role of perceived significant others’ responses on patient outcomes and recommendations for future research.

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Fatigue in Aviation: Safety Risks, Preventive Strategies and Pharmacological Interventions

Frontiers in Physiology ◽

10.3389/fphys.2021.712628 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yara Q. Wingelaar-Jagt ◽

Thijs T. Wingelaar ◽

Wim J. Riedel ◽

Johannes G. Ramaekers

Keyword(s):

Work Load ◽

Chronic Fatigue ◽

Future Research ◽

Preventive Strategies ◽

Military Operations ◽

Circadian Phase ◽

Fatigue Management ◽

Safety Risks ◽

Military Aviation ◽

Time Awake

Fatigue poses an important safety risk to civil and military aviation. In addition to decreasing performance in-flight (chronic) fatigue has negative long-term health effects. Possible causes of fatigue include sleep loss, extended time awake, circadian phase irregularities and work load. Despite regulations limiting flight time and enabling optimal rostering, fatigue cannot be prevented completely. Especially in military operations, where limits may be extended due to operational necessities, it is impossible to rely solely on regulations to prevent fatigue. Fatigue management, consisting of preventive strategies and operational countermeasures, such as pre-flight naps and pharmaceuticals that either promote adequate sleep (hypnotics or chronobiotics) or enhance performance (stimulants), may be required to mitigate fatigue in challenging (military) aviation operations. This review describes the pathophysiology, epidemiology and effects of fatigue and its impact on aviation, as well as several aspects of fatigue management and recommendations for future research in this field.

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Belichaamde ervaringen van patiënten met ernstige chronische vermoeidheid na kanker

KWALON ◽

10.5117/2020.025.003.006 ◽

2020 ◽

Vol 25 (3) ◽

Author(s):

Tom Bootsma ◽

Melanie Schellekens ◽

Rosalie van Woezik ◽

Marije van der Lee ◽

Jenny Slatman

Keyword(s):

Interpretative Phenomenological Analysis ◽

Phenomenological Study ◽

Chronic Fatigue ◽

The Body ◽

Future Research ◽

Cancer Related Fatigue ◽

Embodied Experiences ◽

After Cancer ◽

Insight Into ◽

Philosophical Phenomenology

Embodied experiences of patients with severe chronic fatigue after cancer. An interpretive phenomenological study This article presents a phenomenological study on embodied experiences based on interviews with 25 patients with severe chronic cancer-related fatigue (CCRF). Insight into the patient’s perspective can help to facilitate personalized treatment in CCRF. Theoretically resorting to philosophical phenomenology, we explored embodied experiences of living with CCRF. Using interpretative phenomenological analysis, we identified four superordinate themes: (1) Worn out; (2) Diminishment of one’s ‘I can’; (3) Socially invisible objectification of the body; and (4) Restoring one’s ‘I can’. For clinical practice, these results suggest that focusing on the body and restoring one’s ‘I can’ could be helpful during treatment of CCRF. Future research should focus on measuring individual patterns of CCRF symptoms in order to personalize treatment.

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Heterogeneity in chronic fatigue syndrome – empirically defined subgroups from the PACE trial

Psychological Medicine ◽

10.1017/s0033291716003615 ◽

2017 ◽

Vol 47 (8) ◽

pp. 1454-1465 ◽

Cited By ~ 16

Author(s):

T. E. Williams ◽

T. Chalder ◽

M. Sharpe ◽

P. D. White

Keyword(s):

Chronic Fatigue Syndrome ◽

Latent Class ◽

Principal Component ◽

Chronic Fatigue ◽

Future Research ◽

Fatigue Syndrome ◽

Biological Variables ◽

Variable Reduction ◽

Combined Features ◽

Irritable Bowel

BackgroundChronic fatigue syndrome is likely to be a heterogeneous condition. Previous studies have empirically defined subgroups using combinations of clinical and biological variables. We aimed to explore the heterogeneity of chronic fatigue syndrome.MethodWe used baseline data from the PACE trial, which included 640 participants with chronic fatigue syndrome. Variable reduction, using a combination of clinical knowledge and principal component analyses, produced a final dataset of 26 variables for 541 patients. Latent class analysis was then used to empirically define subgroups.ResultsThe most statistically significant and clinically recognizable model comprised five subgroups. The largest, ‘core’ subgroup (33% of participants), had relatively low scores across all domains and good self-efficacy. A further three subgroups were defined by: the presence of mood disorders (21%); the presence of features of other functional somatic syndromes (such as fibromyalgia or irritable bowel syndrome) (21%); or by many symptoms – a group which combined features of both of the above (14%). The smallest ‘avoidant–inactive’ subgroup was characterized by physical inactivity, belief that symptoms were entirely physical in nature, and fear that they indicated harm (11%). Differences in the severity of fatigue and disability provided some discriminative validation of the subgroups.ConclusionsIn addition to providing further evidence for the heterogeneity of chronic fatigue syndrome, the subgroups identified may aid future research into the important aetiological factors of specific subtypes of chronic fatigue syndrome and the development of more personalized treatment approaches.

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Genetics and Gene Expression Involving Stress and Distress Pathways in Fibromyalgia with and without Comorbid Chronic Fatigue Syndrome

Pain Research and Treatment ◽

10.1155/2012/427869 ◽

2012 ◽

Vol 2012 ◽

pp. 1-13 ◽

Cited By ~ 6

Author(s):

Kathleen C. Light ◽

Andrea T. White ◽

Scott Tadler ◽

Eli Iacob ◽

Alan R. Light

Keyword(s):

Gene Expression ◽

Chronic Fatigue Syndrome ◽

Expression Profiles ◽

Gene Expression Profiles ◽

Chronic Fatigue ◽

Future Research ◽

Sensory Receptor ◽

Methyl Transferase ◽

Fatigue Syndrome ◽

Inherited Susceptibility

In complex multisymptom disorders like fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS) that are defined primarily by subjective symptoms, genetic and gene expression profiles can provide very useful objective information. This paper summarizes research on genes that may be linked to increased susceptibility in developing and maintaining these disorders, and research on resting and stressor-evoked changes in leukocyte gene expression, highlighting physiological pathways linked to stress and distress. These include the adrenergic nervous system, the hypothalamic-pituitary-adrenal axis and serotonergic pathways, and exercise responsive metabolite-detecting ion channels. The findings to date provide some support for both inherited susceptibility and/or physiological dysregulation in all three systems, particularly for catechol-O-methyl transferase (COMT) genes, the glucocorticoid and the related mineralocorticoid receptors (NR3C1, NR3C2), and the purinergic 2X4 (P2X4) ion channel involved as a sensory receptor for muscle pain and fatigue and also in upregulation of spinal microglia in chronic pain models. Methodological concerns for future research, including potential influences of comorbid clinical depression and antidepressants and other medications, on gene expression are also addressed.

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Long-term predictors of outcome in fatigued employees on sick leave: a 4-year follow-up study

Psychological Medicine ◽

10.1017/s0033291706008099 ◽

2006 ◽

Vol 36 (9) ◽

pp. 1293-1300 ◽

Cited By ~ 12

Author(s):

STEPHANIE S. LEONE ◽

MARCUS J. H. HUIBERS ◽

IJMERT KANT ◽

CONSTANT P. VAN SCHAYCK ◽

GIJS BLEIJENBERG ◽

...

Keyword(s):

Sick Leave ◽

Functional Status ◽

Physical Functioning ◽

Work Disability ◽

Female Gender ◽

Chronic Fatigue ◽

Future Research ◽

Fatigue Syndrome

Background. Persistent fatigue is strongly associated with functional status and can lead to absenteeism and work disability. Despite several prognostic studies on chronic fatigue, little attention has been paid to occupational outcomes.Method. A total of 127 fatigued employees on sick leave were followed-up after 4 years to determine long-term predictors of work disability, fatigue caseness and chronic fatigue syndrome (CFS)-like caseness. Measures included fatigue, physical functioning, illness attributions, psychological problems and emotional exhaustion.Results. Thirty-three participants (26%) were receiving work disability benefits at the 4-year follow-up. Older age and lower levels of physical functioning predicted work disability. Weaker psychological attributions and lower levels of physical functioning were predictors of fatigue caseness. CFS-like caseness was predicted by female gender and lower levels of physical functioning. Self-reported physical functioning remained a strong and statistically significant determinant of work disability [odds ratio (OR) 0·45, 95% confidence interval (CI) 0·24–0·87] and CFS-like caseness (OR 0·20, 95% CI 0·09–0·43) after controlling for confounders.Conclusions. This study suggests that physical functioning plays an important role in the persistence of fatigue complaints and work disability in employees on sick leave. The course of fatigue is a complex process, and exploring temporal relationships between fatigue, functional status and work status in future research could provide valuable information for the improvement of fatigue management.

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The Neurological Symptoms of Long COVID-19: A Comparison with other Neurological Conditions and Implications for Healthcare Services

10.1101/2020.07.21.20158816 ◽

2020 ◽

Author(s):

Tamar Wildwing ◽

Nicole Holt

Keyword(s):

Systematic Reviews ◽

Health Professionals ◽

Neurological Disorders ◽

Waiting Times ◽

Chronic Fatigue ◽

Healthcare Services ◽

Neurological Symptoms ◽

Future Research ◽

Systematic Overview ◽

Neurological Conditions

Objective: In response to the rapid spread of COVID-19, this paper provides health professionals with better accessibility to available evidence, summarising findings from a systematic overview of systematic reviews of the neurological symptoms seen in patients with COVID-19. Implications of so-called Long Covid on neurological services and primary care and similarities with other neurological disorders are discussed. Methods: Firstly, a systematic overview of current reviews of neurological symptoms of COVID-19 was conducted. Secondly the implications of these findings are discussed in relation to the potential effect on neurological services and the similarities in the experience of patients with COVID-19 and those with other neurological disorders. Results: Twenty-nine systematic reviews were identified within seven databases, published between 11th April 2020 and 27th August 2020. The results indicated (so far), that COVID-19 exhibits two types of neurological symptoms; life threatening symptoms such as Guillain Barre Syndrome and encephalitis, and less devastating symptoms such as fatigue and myalgia. These so-called lesser symptoms appear to be emerging as longer-term for some sufferers and have been recently labelled Long Covid. When compared, these Long Covid symptoms are very similar to other neurological conditions such as Chronic Fatigue Syndrome (CFS) and Functional Neurological Disorder (FND). Conclusions: Implications for neurological healthcare services in the UK may include longer waiting times and a need for more resources (including more qualified health professionals). There is also a possible change-effect on perceptions of other neurological conditions such as CFS and FND, particularly for health professionals. Future research is recommended to explore changes in perceptions of neurological symptoms because of COVID-19, particularly for health professionals.

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Lessons From Heat Stroke for Understanding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Frontiers in Neurology ◽

10.3389/fneur.2021.789784 ◽

2021 ◽

Vol 12 ◽

Author(s):

Dominic Stanculescu ◽

Nuno Sepúlveda ◽

Chin Leong Lim ◽

Jonas Bergquist

Keyword(s):

Chronic Fatigue Syndrome ◽

Cell Injury ◽

Heat Stroke ◽

Chronic Fatigue ◽

Myalgic Encephalomyelitis ◽

Future Research ◽

Coagulation Disorder ◽

Gene Expressions ◽

Fatigue Syndrome ◽

Central Nervous System Dysfunction

We here provide an overview of the pathophysiological mechanisms during heat stroke and describe similar mechanisms found in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Both conditions are characterized by disturbed homeostasis in which inflammatory pathways play a central role. Splanchnic vasoconstriction, increased gut permeability, gut-related endotoxemia, systemic inflammatory response, central nervous system dysfunction, blood coagulation disorder, endothelial-cell injury, and mitochondrial dysfunction underlie heat stroke. These mechanisms have also been documented in ME/CFS. Moreover, initial transcriptomic studies suggest that similar gene expressions are altered in both heat stroke and ME/CFS. Finally, some predisposing factors for heat stroke, such as pre-existing inflammation or infection, overlap with those for ME/CFS. Notwithstanding important differences - and despite heat stroke being an acute condition - the overlaps between heat stroke and ME/CFS suggest common pathways in the physiological responses to very different forms of stressors, which are manifested in different clinical outcomes. The human studies and animal models of heat stroke provide an explanation for the self-perpetuation of homeostatic imbalance centered around intestinal wall injury, which could also inform the understanding of ME/CFS. Moreover, the studies of novel therapeutics for heat stroke might provide new avenues for the treatment of ME/CFS. Future research should be conducted to investigate the similarities between heat stroke and ME/CFS to help identify the potential treatments for ME/CFS.

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Perspectives of Family Medicine Physicians and Licensed Acupuncture Clinicians on Caring for Persons With Unexplained Chronic Fatigue

Complementary health practice review ◽

10.1177/1533210107306842 ◽

2007 ◽

Vol 12 (3) ◽

pp. 196-202

Author(s):

Jeanette M. Daly ◽

Arthur J. Hartz

Keyword(s):

Family Medicine ◽

Health Care Providers ◽

Nurse Practitioners ◽

Family Physicians ◽

Chronic Fatigue ◽

Future Research ◽

Care Providers ◽

Medical Practitioners ◽

Treatment Regimens ◽

Wide Range

Unexplained chronic fatigue (UCF) is a poorly understood condition with little known about its etiology and treatment. A wide range of health care providers, including physicians, nurse practitioners, and complementary and alternative medical practitioners, offer services for persons with UCF. This study explored perspectives of family medicine physicians and licensed acupuncture clinicians with experience in treating patients with UCF, regarding their treatment regimens and perceived success at improving their patients' energy and coping with symptoms. A sample of 141 family medicine physicians and licensed acupuncturists was surveyed via a questionnaire; 48 returned the completed questionnaire. Clinicians reported treating from 3 to 375 patients with UCF. Family physicians provided more conventional methods, and licensed acupuncturists provided alternative treatments. The reported success of the licensed acupuncturists at improving energy and stamina and helping patients cope with fatigue was significantly higher than that of the family physicians. Implications for future research are discussed.

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Cancer Survivorship: A Positive Side Effect of More Successful Cancer Treatment

European Oncology & Haematology ◽

10.17925/eoh.2013.09.2.74 ◽

2013 ◽

Vol 09 (02) ◽

pp. 74 ◽

Cited By ~ 2

Author(s):

Elizabeth Charlotte Moser ◽

Safaa Ramadan ◽

John Bean ◽

Françoise Meunier ◽

◽

...

Keyword(s):

Cancer Survivors ◽

Cancer Survivorship ◽

Task Force ◽

Survival Rates ◽

Chronic Fatigue ◽

New Drugs ◽

Future Research ◽

Policy Makers ◽

Positive Side ◽

Work Education

Over the past decades, survival rates of cancer patients have increased impressively through the introduction of screening, new drugs and more personalised multi-modality treatments. This success in treating cancer has resulted in a large and rapidly increasing number of cancer survivors. Unfortunately, now that cancer is controlled in many patients, it has become clear that the life expectancy and quality of life of cancer survivors may be compromised by a spectrum of late adverse treatment effects. Some cancer survivors encounter second malignancies, severe cardiovascular or other morbidities which impair normal life in an important way. Some patients may be confronted with difficulties such as societal discrimination due to slower performance, chronic fatigue or partial inability, acceptance for work, education, insurance or credit history. To address these new issues, the EORTC is launching a variety of initiatives. Early in 2013, the EORTC Cancer Survivorship Task Force was created. The 1st EORTC Cancer Survivorship Summit will take place 30–31 January 2014 to facilitate interaction between clinicians, researchers, social workers, patients, insurers, bankers and policy makers. This summit will address the situation and needs of cancer survivors and guide future research and health policies in Europe in this field.

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