A Systematic Review of Biological Mechanisms of Fatigue in Chronic Illness

Fatigue, a commonly reported symptom, is defined as an overwhelming, debilitating, and sustained sense of exhaustion that decreases the ability to function and carry out daily activities. To date, cancer researchers have been in the forefront in investigating the possible biological mechanisms of fatigue, identifying inflammation, dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, and activation of the autonomic nervous system. The purpose of this systematic review is to describe fatigue and what is known about the biological mechanisms described in cancer in five chronic, noninfectious illnesses: heart failure, multiple sclerosis, chronic kidney disease, rheumatoid arthritis, and chronic obstructive pulmonary disease. We searched PubMed and EMBASE using fatigue as a major Medical subject headings (MeSH) heading with each individual disease added as a search term followed by each biological mechanism. We included only primary research articles published in English between 1996 and 2016 describing studies conducted in adult humans. We identified 26 relevant articles. While there is some evidence that the biological mechanisms causing fatigue in cancer are also associated with fatigue in other chronic illnesses, more research is needed to explore inflammation, the HPA axis, and the autonomic nervous system, and other mechanisms in relation to fatigue in a variety of chronic illnesses.

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Hypothalamic-pituitary-adrenal axis and autonomic nervous system reactivity in children prenatally exposed to maternal depression: A systematic review of prospective studies

Neuroscience & Biobehavioral Reviews ◽

10.1016/j.neubiorev.2018.05.033 ◽

2020 ◽

Vol 117 ◽

pp. 243-252 ◽

Cited By ~ 5

Author(s):

Laura S. Bleker ◽

Lotte van Dammen ◽

Mariska M.G. Leeflang ◽

Jacqueline Limpens ◽

Tessa J. Roseboom ◽

...

Keyword(s):

Systematic Review ◽

Nervous System ◽

Autonomic Nervous System ◽

Maternal Depression ◽

Prospective Studies ◽

Prenatally Exposed ◽

Hypothalamic Pituitary Adrenal ◽

Autonomic Nervous ◽

Adrenal Axis ◽

Pituitary Adrenal Axis

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December 2019 issue – The Bridge

10.13056/acamh.9715 ◽

2019 ◽

Keyword(s):

Systematic Review ◽

Nervous System ◽

Autonomic Nervous System ◽

Young People ◽

Intolerance Of Uncertainty ◽

Environmental Noise ◽

Parental Consanguinity ◽

Autonomic Nervous ◽

Autistic Symptoms ◽

Teacher Assessments

Summaries include; if parental consanguinity predicts the severity of Autistic symptoms; study the transmission of intergenerational anxiety in families; systematic review into the effectiveness of available interventions to treat PTSD; the efficacy of teacher assessments vs exams to assess performance in UK schools; relationship between intolerance of uncertainty and extreme demand avoidance in young people with Autism; and how fluctuations in external environmental noise affect the developing Autonomic Nervous System in babies.

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Alterations in HPA-axis and autonomic nervous system functioning in childhood anxiety disorders point to a chronic stress hypothesis

Psychoneuroendocrinology ◽

10.1016/j.psyneuen.2014.09.002 ◽

2015 ◽

Vol 51 ◽

pp. 135-150 ◽

Cited By ~ 58

Author(s):

Gwendolyn C. Dieleman ◽

Anja C. Huizink ◽

Joke H.M. Tulen ◽

Elisabeth M.W.J. Utens ◽

Hanneke E. Creemers ◽

...

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

Anxiety Disorders ◽

Chronic Stress ◽

Hpa Axis ◽

Childhood Anxiety ◽

Childhood Anxiety Disorders ◽

Autonomic Nervous ◽

System Functioning

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Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis

Journal of Psychiatry and Neuroscience ◽

10.1503/jpn.140217 ◽

2016 ◽

Vol 41 (2) ◽

pp. 89-104 ◽

Cited By ~ 132

Author(s):

Gail A. Alvares ◽

Daniel S. Quintana ◽

Ian B. Hickie ◽

Adam J. Guastella

Keyword(s):

Systematic Review ◽

Nervous System ◽

Autonomic Nervous System ◽

Psychiatric Disorders ◽

Meta Analysis ◽

Psychotropic Medications ◽

Autonomic Nervous System Dysfunction ◽

Autonomic Nervous ◽

The Impact

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Autonomic Nervous System Changes in Individuals with Anxiety and Depression Across the Lifespan: A Systematic Review

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2020.09.351 ◽

2020 ◽

Vol 101 (11) ◽

pp. e115

Author(s):

Karin Steere ◽

Anna Ortung ◽

Brandon Funk ◽

Justin Peterson ◽

Rachel Sannicandro

Keyword(s):

Systematic Review ◽

Nervous System ◽

Autonomic Nervous System ◽

Anxiety And Depression ◽

Autonomic Nervous ◽

System Changes

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Effectiveness of an osteopathic treatment on the autonomic nervous system: a systematic review of the literature

European Journal of Medical Research ◽

10.1186/s40001-019-0394-5 ◽

2019 ◽

Vol 24 (1) ◽

Cited By ~ 2

Author(s):

Verena Rechberger ◽

Michael Biberschick ◽

Jan Porthun

Keyword(s):

Systematic Review ◽

Nervous System ◽

Autonomic Nervous System ◽

Methodological Quality ◽

Assessment Tools ◽

Controlled Trials ◽

Level Of Evidence ◽

Autonomic Nervous ◽

Osteopathic Treatment ◽

Significant Change

Abstract Objective The objective of this systematic review was to evaluate the effectiveness of an osteopathic treatment on the autonomic nervous system (ANS). For this purpose, published primary studies were analysed and critically evaluated. Method To generate this review, 15 electronic databases were systematically searched for studies. Randomized clinical controlled trials (RCT) and clinical controlled trials (CCT) are included in the review and evaluated with appropriate assessment tools (Downs and Black Checklist and the checklist from Kienle and Kiene). Results 23 published studies (10 RCT, 1 clinic multi-centre study, 1 CCT, 5 randomized cross-over studies, 5 randomized pilot studies and 1 single case study) are included in this review. The studies were evaluated with the assessment tools according to their quality. 3 studies are graded as high quality, 11 as moderate and 8 as low-quality studies. Conclusion The included published studies represent a good level of evidence. Due to a small number of subjects and no follow-ups, the methodological quality is rated as moderate. A significant change on the ANS was shown in studies including High-Velocity Low-Amplitude Techniques (HVLAT). No statement could be drawn in studies in which they used cranial osteopathic techniques due to the lack of methodological quality. A significant change on the ANS is shown in the treatment of the suboccipital region. In studies which evaluated the effectiveness of mobilization in the cervical and thoracic region, no statement could be displayed due to a low level of evidence. None of the findings in these studies have given statements if ANS activation takes place in the sympathetic or parasympathetic system.

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