The contribution of pain, reported sleep quality, and depressive symptoms to fatigue in fibromyalgia A mind-body technique for symptoms related to fibromyalgia and chronic fatigue. Assessing fibromyalgia-related fatigue: content validity and psychometric performance of the Fatigue Visual Analog Scale in adult patients with fibromyalgia. Fatigue. Measures and relation to pain Psychological symptoms, somatic symptoms, and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting. Fatigue, not self-rated motor symptom severity, affects quality of life in functional motor disorders Modafinil treatment for fatigue associated with fibromyalgia. Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy individuals. Improvement in multiple dimensions of fatigue in patients with fibromyalgia treated with duloxetine: secondary analysis of a randomized, placebo-controlled trial A psychological profile of fibromyalgia patients: a chiropractic case study. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities. Patients with Fibromyalgia Benefit from Aerobic Endurance Exercise Health status and disease severity in fibromyalgia: results of a six-center longitudinal study. Fatigue in patients with chronic obstructive pulmonary disease. Multidisciplinary treatment of fibromyalgia: does cognitive behavior therapy increase the response to treatment? Fibromyalgia: the role of sleep in affect and in negative event reactivity and recovery. Fatigue in multiple sclerosis: multidimensional assessment and response to symptomatic treatment
& NA ; The major objective of this research was to evaluate the predictors of fatigue in patients with fibromyalgia ( FM ) , using cross‐sectional and daily assessment method ologies . In the cross‐sectional phase of the research involving a sample of 105 FM patients , greater depression and lower sleep quality were concurrently associated with higher fatigue . While pain was correlated with fatigue , it did not independently contribute to fatigue in the regression equation . For a subset of patients from the cross‐sectional sample ( n=63 ) who participated in a week of prospect i ve daily assessment of their pain , sleep quality , and fatigue , multiple regression analysis of aggregated ( averaged ) daily scores revealed that previous day 's pain and sleep quality predicted next day 's fatigue . Depression from the cross‐sectional phase was not related to aggregated daily fatigue scores . A path analytic framework was tested with disaggregated ( removing between subjects variability ) data in which pain was predicted to contribute to lower sleep quality which , in turn , was predicted to lead to greater fatigue . The results revealed that poor sleep quality fully accounted for the positive relationship between pain and fatigue , thus substantiating the mediational role of sleep quality . The findings are indicative of a dysfunctional , cyclical pattern of heightened pain and non‐restful sleep underlying the experience of fatigue in FM CONTEXT A novel mind-body approach ( amygdala retraining ) is hypothesized to improve symptoms related to  fibromyalgia and chronic fatigue .  OBJECTIVE To examine the use of a mind-body approach for improving symptoms related to  fibromyalgia and chronic fatigue .  DESIGN This was a single-blind , r and omized controlled trial . SETTING The study was conducted in a tertiary-care fibromyalgia and chronic fatigue clinic . PATIENTS Patients with fibromyalgia , chronic fatigue , or both were included . INTERVENTIONS Patients were r and omly assigned to receive amygdala retraining along with st and ard care or st and ard care alone . St and ard care involved attending a 1.5-day multidisciplinary program . The amygdala retraining group received an additional 2.5-hour training course in which the key tools and techniques adapted from an existing program were taught to the patient . A home- study video course and associated text were provided to supplement the on-site program . Both groups received telephone calls twice a month to answer questions related to technique and to provide support . MAIN OUTCOME MEASURES Vali date d self-report question naires related to general health , well-being , and symptoms , including Short Form-36 , Measure Yourself Medical Outcome Profile , Multidimensional Fatigue Inventory , Epworth Sleepiness Scale , and Fibromyalgia Impact Question naire . RESULTS Of the 44 patients r and omly assigned who completed baseline assessment s , 21 patients completed the study ( 14 in the st and ard care group and 7 in the study group ) . Median age was 48 years ( range , 27 - 56 years ) , and female subjects comprised 91 % of the group . Analyses demonstrated statistically significant improvements in scores for physical health , energy , pain , symptom distress , and fatigue in patients who received the amygdala retraining compared with st and ard care OBJECTIVES To document 1 ) the content validity and 2 ) measure improvements in fatigue , using the  Fatigue Visual Analogue Scale ( VAS ) assessment tool in patients with fibromyalgia . METHODS The relevance and comprehensiveness of the Fatigue VAS were tested through a qualitative analysis of 20 subjects ' verbatim transcripts from semi-structured qualitative interviews . Data from two r and omised , controller trials in fibromyalgia ( n=1121 ) were used to conduct correlation analyses with the  Fatigue and Tiredness  items from the Fibromyalgia Impact Question naire ( FIQ ) and the Short Form-36 Vitality scale . Known-groups and cross classification analyses were conducted to demonstrate the ability to measure improvement in fatigue using the Fatigue VAS . RESULTS All subjects spontaneously reported that fatigue was an important symptom to capture in fibromyalgia . The Fatigue VAS was well understood by most subjects ( n=18/20 ) . High correlations ( Pearson r>0.75 ) and good agreement ( k>0.66 ) were found between the Fatigue VAS and the FIQ tiredness items no. 16 and 17 and SF-36 ™ Vitality scale . In both clinical trials there was a substantial separation of approximately 20 points on the mean change in the Fatigue VAS score between responders ( > 30 % improvement in pain VAS ) and non-responders . CONCLUSIONS Previous studies have confirmed that fatigue is a major component of the fibromyalgia experience . This current study reports that fibromyalgia patients spontaneously rated fatigue as a highly significant feature of their illness , and supports the use of the Fatigue VAS as a valid question naire in fibromyalgia clinical trials Fatigue describes reduced capacity to sustain force or power output , reduced capacity to perform multiple tasks over time and simply a subjective experience of feeling exhausted , tired , weak or having lack of energy . Pain and fatigue have several components in common , such as being subjective , prevalent in most patients with cancer and caused by multiple factors of both a physical and psychological nature . In order to explore the relationship between fatigue and pain , data from five studies were used : two r and om sample s from the Norwegian population ( n=2323 and n=1965 ) , Hodgkin ’s disease survivors ( n=459 ) , palliative care patients ( n=434 ) and patients with bone metastases ( n=94 ) . All patients had completed one or more of the following instruments : EORTC QLQ‐C30 , SF‐36 and /or Fatigue Question  naire . The level of fatigue was much higher in the two palliative care population s ( 54.4 and 63.2 ) as compared to the normal population sample s ( 25.0 ) . Patients with bone metastases had significantly more pain ( 72.0 ) than the patients in the palliative care trial ( 47.4 ) and norms ( 20.5 ) . In the two palliative care and bone metastases population s fatigue was almost unchanged over time , while pain was reduced . In the palliative care population a high level of fatigue ( 80.3 ) and pain ( 57.8 ) was reported 0–1 month before death . The relationship between pain , fatigue and the health‐related quality of life domains should be explored in more detail , especially in follow‐up studies in order to assess possible changes over time . In addition , the validity of the existing instruments measuring fatigue should be investigated for use in patients with advanced disease and short life expectancy OBJECTIVE This study assessed relationships among psychological symptoms , past and current psychiatric disorder , functional impairment , somatic symptoms , chronic fatigue , and chronic fatigue syndrome . METHOD A prospect i ve cohort study was followed by a nested case-control study . The subjects , aged 18 - 45 years , had been in primary care for either clinical viral infections or a range of other problems .  Question naire measures of fatigue and psychological symptoms were completed by 1,985 subjects 6 months later ; 214 subjects with chronic fatigue were then compared with 214 matched subjects without fatigue . Assessment s were made with question naires , interviews , and medical records of fatigue , somatic symptoms , psychiatric disorder , and functional impairment . RESULTS Subjects with chronic fatigue were at greater risk than those without chronic fatigue for current psychiatric disorder assessed by st and ardized interview ( 60 % versus 19 % ) or by question naire ( 71 % versus 31 % ) . Chronic fatigue subjects were more likely to have received psychotropic medication or experienced psychiatric disorder in the past . There was a trend for previous psychiatric disorder to be associated with comorbid rather than noncomorbid chronic fatigue . Most subjects with chronic fatigue syndrome also had current psychiatric disorder when assessed by interview ( 75 % ) or question naire ( 78 % ) . Both the prevalence and incidence of chronic fatigue syndrome were associated with measures of previous psychiatric disorder . The number of symptoms suggested as characteristics of chronic fatigue syndrome was closely related to the total number of somatic symptoms and to measures of psychiatric disorder . Only postexertion malaise , muscle weakness , and myalgia were significantly more likely to be observed in chronic fatigue syndrome than in chronic fatigue . CONCLUSIONS Most subjects with chronic fatigue or chronic fatigue syndrome in primary care also meet criteria for a current psychiatric disorder . Both chronic fatigue and chronic fatigue syndrome are associated with previous psychiatric disorder , partly explained by high rates of current psychiatric disorder . The symptoms thought to represent a specific process in chronic fatigue syndrome may be related to the joint experience of somatic and psychological distress While fatigue is found to be an impairing symptom in functional motor disorders ( FMD ) in clinical practice , scientific evidence is lacking . We investigated fatigue severity and subtypes in FMD compared to organic neurological disease . Furthermore , the role of fatigue within FMD and its impact on quality of life and self-rated health were investigated . Data from 181 patients participating in the self-help on the internet for functional motor disorders , r and omised Trial were included . Data from 217 neurological controls with neuromuscular disorders ( NMD ) originated from a historical cohort .  Fatigue was measured using the checklist individual strength ( CIS ) . Motor symptom severity , depression and anxiety were correlated to fatigue . For multivariable regression analyses , physical functioning and pain were additionally taken into account . Severe fatigue was , respectively , present in 78 and 53 % of FMD and NMD patients ( p < 0.001 ) . FMD patients scored higher than NMD patients on all fatigue subdomains ( p < 0.001 ) . In the FMD group , fatigue subdomains were correlated to depression , anxiety and partly to motor symptom severity . Quality of life was negatively associated with fatigue [ OR 0.93 ( 0.90–0.96 ) , p < 0.001 ] and depression [ OR 0.87 ( 0.81–0.93 ) , p < 0.001 ] , but not self-rated motor symptom severity . Self-rated health was negatively associated with fatigue [ OR 0.92 ( 0.88–0.96 ) , p < 0.001 ] and pain [ OR 0.98 ( 0.97–0.99 ) , p < 0.001 ] . Fatigue was found to be a prevalent problem in FMD , more so than in organic neurological disease . It significantly affected quality of life and self-rated health , while other factors such as motor symptom severity did not . Fatigue should be taken into account in clinical practice and treatment trials Fatigue , which may occasionally be the chief manifestation , is present in more than 90 % of patients with fibromyalgia . It is a significant cause of morbidity and is quite disabling in its ability to disrupt quality of life . The cause of fatigue is complex , but disturbances in sleep architecture may have a role to play . Modafinil , a nonamphetamine wake-promoting agent and a popular treatment of narcolepsy , displays its antifatigue properties through a potentially central prohistaminergic interplay and may conceptually be postulated to lower fatigue in fibromylagia patients as well . Modafinil , unlike amphetamines , is well tolerated with less peripheral hemodynamic alterations combined with low abuse and tolerance sequelae . It also improves vigilance in sleep-deprived patients . Modafinil has been suggested as a possible treatment of fatigue in multiple sclerosis , parkinsonism , depression , primary biliary cirrhosis among other disorders with some demonstrable benefit . Since fatigue constitutes a significant proportion of the morbidity associated with fibromyalgia , we have conducted a retrospective chart review of 98 patients who have fibromyalgia , were being treated by a rheumatologist and 2 nurse practitioners in a private practice setting , and had been given a prescription for modafinil .  Patients were involved in this usual practice setting , and the clinicians documented patient encounters in a st and ard medical record format . The charts were review ed by 5 outside psychiatric clinicians from SUNY Upstate Medical University ’s Depression and Anxiety Disorders Research Program . The study team attempted to exclude charts where there may have been other medical comorbidities that may have induced fatigue and also excluded charts where the initiation of modafinil coincided with the initiation of any other off-label fibromyalgia treatment ( i.e. , duloxetine , amytriptyline , tramadol , etc ) . An analog rating scale was created for this chart review as notes had to be read by study clinicians and retrospective assessment s were made regarding any change in fatigue . This simple scale used a method of visual quantitation of subjective symptomatology change with regard to fatigue . This ranged from a level of 1 , indicative of low fatigue , to 10 , as a representative of the diametrically opposite extreme of marked symptom fatigue . The 5 clinician raters were calibrated to 0.8 accuracy to decrease inter-rater reliability bias . Progress notes were also scanned for reported side effects and for reasons why modafinil may have been discontinued . The average age of the patients was 47 years , and the average dose of modafinil was 162 mg/d , with an average duration of treatment spanning 2 years . The average number of concomitant medications was eight . The mean pre and postfatigue analog scale scores were analyzed and significant statistical difference was demonstrated whereby modafinil augmentation lowered patient fatigue levels from 7.2 0.13 ( severe fatigue ) to 4.4 0.18 ( low-moderate fatigue ( P 0.001 ) . The net mean improvement in fatigue as a target symptom was approximately 28 % . There is often little focus on the fatigue that is commonly reported by these patients . Our simple , retrospective study may be the first that focuses on the use of modafinil for alleviating this symptom . In our retrospective chart review , we found a majority of patients to be involved in both polypharmacy regimens and nonpharmacologic treatment ( i.e. , biofeedback ) as well . The timing of modafinil addition and fatigue amelioration suggests that this agent may be able to effectively treat the fatigue associated with fibromyalgia . It is also a well-tolerated drug with a minimum of side effects reported . These observations should encourage the development of prospect i ve controlled studies BACKGROUND Chronic fatigue syndrome ( CFS ) is a condition that may be associated with substantial disability . The Medical Outcomes Study Short-Form General Health Survey ( SF-36 ) is an instrument that has been widely used in outpatient population s to determine functional status . Our objectives were to describe the usefulness of the SF-36 in CFS patients and to determine if subscale scores could distinguish patients with CFS from subjects with unexplained chronic fatigue ( CF ) , major depression ( MD ) , or acute infectious mononucleosis ( AIM ) , and from healthy control subjects ( HC ) . An additional goal was to ascertain if subscale scores correlated with the signs and symptoms of CFS or the presence of psychiatric disorders and fibromyalgia . DESIGN Prospect ively collected case series . SETTING Patients with CFS and CF were seen in a university-based referral clinic and had undergone a complete medical and psychiatric evaluation . Other study subjects were recruited from the community to participate in research studies . PARTICIPANTS The study included 185 patients with CFS , 246 with CF , 111 with AIM , and 25 with MD . There were 99 HC subjects . MEASURES The  SF-36 and a structured psychiatric interview  were used . The SF-36 contains 8 subscales : physical , emotional , social , and role functioning , body pain , mental health , vitality , and general health- and a structured psychiatric interview .  RESULTS Performance characteristics ( internal reliability coefficients , convergent validity ) of the SF-36 were excellent . A strikingly consistent pattern was found for the physical functioning , role functioning , social functioning , general health , and body pain subscales , with the lowest scores in CFS patients , intermediate scores in AIM patients , and the highest scores in the HC subjects . The CFS patients had significantly lower scores than patients with CF alone on the physical functioning ( P < or = 0.01 ) , role functioning ( P < or = 0.01 ) , and body pain ( P < or = 0.001 ) subscales . The emotional functioning and mental health scores were worst among those with MD . The presence of fibromyalgia , being unemployed , and increasing fatigue severity all were associated with additional functional limitations across multiple functional domains , with increasing fatigue appearing to have the greatest effect . CONCLUSIONS The SF-36 is useful in assessing functional status in patients with fatiguing illnesses . Patients with CFS and CF have marked impairment of their functional status . The severity and pattern of impairment as documented by the SF-36 distinguishes patients with CFS and CF from those with MD and AIM , and from HC , but does not discriminate between CF and CFS Introduction Fatigue is one of the most disabling symptoms associated with fibromyalgia that greatly impacts quality of life . Fatigue was assessed as a secondary objective in a 2-phase , 24-week study in out patients with American College of Rheumatology-defined fibromyalgia . Methods Patients were r and omized to duloxetine 60 - 120 mg/d ( N = 263 ) or placebo ( N = 267 ) for the 12-week acute phase . At Week 12 , all placebo-treated patients were switched to double-blind treatment with duloxetine for the extension phase . Fatigue was assessed at baseline and every 4 weeks with the Multidimensional Fatigue Inventory ( MFI ) scales : General Fatigue , Physical Fatigue , Mental Fatigue , Reduced Activity , and Reduced Motivation . Other assessment s that may be associated with fatigue included Brief Pain Inventory ( BPI ) average pain , numerical scales to rate anxiety , depressed mood , bothered by sleep difficulties , and musculoskeletal stiffness . Treatment-emergent fatigue-related events were also assessed . Changes from baseline to Week 12 , and from Week 12 to Week 24 , were analyzed by mixed-effects model repeated measures analysis . Results At Week 12 , duloxetine versus placebo significantly ( all p < .05 ) reduced ratings on each MFI scale , BPI pain , anxiety , depressed mood , and stiffness . Improvement in ratings of being bothered by sleep difficulties was significant only at Weeks 4 and 8 . At Week 24 , mean changes in all measures indicated improvement was maintained for patients who received duloxetine for all 24 weeks ( n = 176 ) . Placebo-treated patients switched to duloxetine ( n = 187 ) had significant within-group improvement in Physical Fatigue ( Weeks 16 , 20 , and 24 ) ; General Fatigue ( Weeks 20 and 24 ) ; Mental Fatigue ( Week 20 ) ; and Reduced Activity ( Weeks 20 and 24 ) . These patients also experienced significant within-group improvement in BPI pain , anxiety , depressed mood , bothered by sleep difficulties , and stiffness . Overall , the most common ( > 5 % incidence ) fatigue-related treatment-emergent adverse events were fatigue , somnolence , and insomnia . Conclusions Treatment with duloxetine significantly improved multiple dimensions of fatigue in patients with fibromyalgia , and improvement was maintained for up to 24 weeks . Trial registration Clinical Trials.gov registry NCT00673452 BACKGROUND Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain and tenderness . Reversible modulation of the pain threshold is believed to contribute to the pathogenesis of this condition , and psychosocial stress is known to alter the pain threshold . OBJECTIVE To describe and compare the psychological profile of fibromyalgia patients attending chiropractic clinics in Australia . SETTING Chiropractic clinics located in 5 Australian states and the Australian capital territory with practice s in inner city , suburban , coastal , and rural areas were included . SUBJECTS Chiropractic patients with acute and chronic biomechanical conditions , fibromyalgia , and who were undergoing maintenance care were included in the study . METHOD A case study to explore the psychological profile of fibromyalgia patients was undertaken . The  Distress and Risk Assessment Method ( DRAM ) and Sense of Coherence ( SOC ) question naires were used to ascertain and compare the distress , sense of coherence , and manageability levels of patients with fibromyalgia with patients having maintenance chiropractic care . Purposive sampling of practitioners and convenience sampling of patients fulfilling the study 's inclusion criteria were undertaken . Patients were asked to complete two question naires and chiropractors to complete one question naire and an interview . RESULTS While more than half of the patients in the fibromyalgia group were distressed , fewer than 1 in 7 maintenance patients were found to be distressed according to the DRAM question naire . With several individual exceptions , fibromyalgia patients also tended to have lower SOC and manageability scores than the maintenance group . CONCLUSION This study supports the view that fibromyalgia may represent a problem of coping with various environmental stresses , including psychosocial stresses . However , owing to individual variation , a diagnosis of fibromyalgia at the clinical level does not accurately predict whether a particular patient is distressed or has a low SOC score . Screening of fibromyalgia patients may help determine whether intensive counseling and stress management by the chiropractor or another health professional should be contemplated BACKGROUND Chronic fatigue syndrome ( CFS ) , fibromyalgia ( FM ) , and multiple chemical sensitivities ( MCS ) are conditions associated with fatigue and a variety of other symptoms that appear to share many clinical and demographic features . Our objectives were to describe the similarities and differences among patients with CFS , FM , and MCS . Additional objectives were to determine how frequently patients with MCS and FM met the criteria for CFS and if they differed in their health locus of control . METHODS  Demographic , clinical , and psychosocial measures were prospect ively collected in 90 patients , 30 each with CFS , FM , and MCS . Patients were recruited from a university-based referral clinic devoted to the evaluation and treatment of chronic fatigue and three private practice s. Variables included demographic features , symptoms characteristic of each condition , psychological complaints , a measure of health locus of control , and information on health care use .  RESULTS Overall , the three patient groups were remarkably similar in demographic characteristics and the presence of specific symptoms . Patients with CFS and FM frequently reported symptoms compatible with MCS .  Likewise , 70 % of patients with FM and 30 % of those with MCS met the criteria for CFS . Health care use was substantial among patients with CFS , FM , and MCS , with an average of 22.1 , 39.7 , and 23.3 visits , respectively , to a medical provider during the prior year . Health locus of control did not differ among the three population s. CONCLUSIONS In general , demographic and clinical factors and health locus of control do not clearly distinguish patients with CFS , FM , and MCS . Symptoms typical of each disorder are prevalent in the other two conditions Abstract : Fibromyalgia ( FM ) is a disorder characterised by diffuse widespread musculoskeletal aching and stiffness and multiple tender points [ 1 ] . Its pathophysiology is poorly understood . The influence of aerobic endurance exercise on pain in patients with FM was investigated . Twenty-seven patients ( 25 female , 2 male ) participated in a controlled clinical study and performed 12 weeks of jogging , walking , cycling or swimming following a given schedule .  Twelve sedentary FM patients ( 11 female , 1 male ) served as controls . Before and after training both the study and the control groups were evaluated spiroergometrically .  Tender point pain was quantified by dolorimetry . The painful body surface was estimated by a pain body diagram , and its intensity by a visual analogue scale and a ranking scale . Patients trained for an average of 25 min two to three times a week , with an average intensity of 50 % of maximal oxygen uptake ( VO2max ) . Unlike the control group , the training group exhibited a decrease in heart rate and VO2 and an increase in respiratory quotient during submaximal workload . Maximal performance capacity and VO2max remained unchanged , whereas the wattpulse ( watt/heart rate ) improved at maximal workload . Pain parameters remained unchanged in the control group , but in the training group the mean number of positive tender points ( 15.4/12.7 ) , the mean pain threshold of the gluteal tender point ( 2.89 kp/3.50 kp ) and the painful body surface ( 18%/15 % body surface ) decreased significantly . Subjective general pain condition deteriorated in two patients but improved in 17 . Our results suggest a positive effect of aerobic endurance exercise on fitness and well-being in patients with FM OBJECTIVE To determine the intermediate and long-term outcomes of fibromyalgia in patients seen in rheumatology centers in which there is special interest in the syndrome . METHODS We conducted a longitudinal outcome study by mailed comprehensive Health Assessment Question naire administered every 6 months to 538 patients , from 6 rheumatology centers , whose median duration of disease at first assessment was 7.8 years . The final assessment took place after 7 years . In addition , there was study followup on 85 patients who had attended the Wichita center for > 10 years . RESULTS Although functional disability worsened slightly and health satisfaction improved slightly , measures of pain , global severity , fatigue , sleep disturbance , anxiety , depression , and health status were markedly abnormal at study initiation and were essentially unchanged over the study period . Correlations between first and last assessment values were as high as r = 0.82 . For some variables , abnormalities were 3 times greater at one center compared with another . CONCLUSION Patients with established fibromyalgia , seen in rheumatology centers in which there a special interest in the disease and followed up for as long as 7 years , have markedly abnormal scores for pain , functional disability , fatigue , sleep disturbance , and psychological status , and these values do not change substantially over time . Half the patients are dissatisfied with their health , and 59 % rate their health as fair or poor . There are marked differences in disease severity among the various centers , but < 14 % of the variance in outcomes can be explained by demographic or center factors . Values at the first assessment are predictive of final values BACKGROUND Fatigue is a frequently occurring symptom in patients with chronic obstructive pulmonary disease ( COPD ) . Despite this , relatively few studies have objective ly assessed patients ' perceptions of fatigue and the impact of perceived fatigue on their everyday lives . OBJECTIVE The purpose of this study was to describe the prevalence , duration and severity of fatigue among patients with COPD and the impact of perceived fatigue on cognitive , physical and psychosocial functioning in comparison with controls . METHOD The  Fatigue Impact Scale , including physical , psychosocial and cognitive dimension and structured questions about the frequency , duration , and severity of fatigue  was mailed to 44 out patients with COPD and 88 r and omly selected age- and sex-matched controls . In total 36 patients and 37 controls completed the question naire . RESULTS Almost half of the patients ( 47.2 % ) , reported fatigue every day during the preceding month compared with 13.5 % of the control group ( P < 0.001 ) . The duration of fatigue was more than 6 hours in 52.7 % of the patients and 44.4 % reported that fatigue was either the worst or one of the worst symptoms they had , compared with 18.9 % ( P < 0.001 ) and 10.8 % ( P < 0.01 ) in the control group . The patients reported a significantly greater impact of fatigue on cognitive , physical and psychosocial functioning compared with the control group ( P < 0.001 ) . CONCLUSION These findings indicate that fatigue is a highly prevalent symptom , which impacts on patients ' functional condition and needs to be professionally assessed and managed OBJECTIVE Multidisciplinary treatments ( MTs ) are usually recommended for reducing fibromyalgia ( FM ) symptoms and include physical exercise , drug management , education , and cognitive behavior therapy ( CBT ) . However , there is no evidence that CBT adds efficacy to the other therapeutic components . This r and omized controlled trial analyzed the response of FM patients to two MTs , with and without CBT , according to the presence of concurrent symptoms . METHODS Eighty-three women with FM were r and omly assigned to MT or combined MT and CBT . The MT included medical intervention , physical training , education , and discussion of the syndrome . The CBT focused on coping with stress , modifying lifestyles , and changing pain behaviors . Demographic and clinical data , information regarding tender points , and question naire responses about functional capability [ Fibromyalgia Impact Question naire ( FIQ ) ] , health status [ 36-item Short Form Health Survey ( SF-36 ) ] , and mental health [ Symptom Checklist-90-Revised ( SCL-90-R ) ] were obtained at the beginning , at the end of the 15-week treatment , and at 6-month follow-up . Subgroups are identified in relation to treatment response . RESULTS Sixty-six women ( 80 % ) completed treatment . Although the variance of the total sample had changed at posttreatment ( F=2.67 , P=.031 ) , there was no significant effect for the TimexTreatment interaction ( F=1.65 , P=.16 ) . Univariate tests detected a significant fall in the FIQ score . The subgroup of patients with fatigue showed a better response with MT+CBT than with MT . At 6-month follow-up , the statistical differences had been maintained . Intention-to-treat analysis ratified these results . CONCLUSIONS MT improves functional capability and reduces symptom impact . CBT increases mildly the effect of MT in patients with fatigue OBJECTIVE Fibromyalgia ( FM ) syndrome is a chronic pain condition characterized by diffuse muscle pain , increased negative mood , and sleep disturbance . Until recently , sleep disturbance in persons with FM has been modeled as the result of the disease process or its associated pain . The current study examined sleep disturbance ( i.e. , sleep duration and sleep quality ) as a predictor of daily affect , stress reactivity , and stress recovery . DESIGN AND MEASURES A hybrid of daily diary and ecological momentary assessment methodology was used to evaluate the psychosocial functioning of 89 women with FM . Participants recorded numeric ratings of pain , fatigue , and positive and negative affect 3 times throughout the day for 30 consecutive days . At the end of each day , participants completed daily diary records of positive and negative life events . In addition , participants reported on their sleep duration and sleep quality each morning . RESULTS After accounting for the effects of positive events , negative events , and pain on daily affect scores , it was found that sleep duration and quality were prospect ively related to affect and fatigue . Furthermore , the effects of inadequate sleep on negative affect were cumulative . In addition , an inadequate amount of sleep prevented affective recovery from days with a high number of negative events . CONCLUSIONS These results lend support to the hypothesis that sleep is a component of allostatic load and has an upstream role in daily functioning Sixty relapsing-remitting multiple sclerosis ( MS ) patients were selected on the basis of their score on the Fatigue Severity Scale ( FSS ) and formed two groups : 40 patients ( fatigued MS ; MSf ) scored above the 75th percentile of a previously assessed representative MS sample ( 100 patients ) , and 20 age- and sex-matched patients ( nonfatigued MS patients ; MSnf ) scored below the 25th percentile . The patients underwent clinical evaluation ( Exp and ed Disability Status Scale ( EDSS ) ) , further assessment of fatigue ( Fatigue Impact Scale ) , scales evaluating depression ( Hamilton Depression Rating Scale ( HDRS ) and Beck ’s Depression Inventory ( BDI ) ) and neuropsychological tests . All patients were evaluated for muscle fatigability and central activation by means of a biomechanical test of sustained contraction ; they also underwent somatosensory evoked potentials ( SSEPs ) and transcranial magnetic stimulation ( TMS ) . The patients of the MSf subgroup were then r and omized to one of the following two treatments : 4-aminopyridine ( 4-AP ) 24 mg/day and fluoxetine ( FLX ) 20 mg/day . After a one-week titration this treatment proceeded for 8 weeks . At the end of the treatment , EDSS , fatigue and depression scores were further evaluated . At baseline , fatigue test scores consistently correlated with depression and cognitive test scores , but not with the fatigability test . Fatigue scores decreased in both treatment groups in a similar way . Due to the design of the study , this can not be disjoined from a placebo effect . The changes of fatigue scores could not be predicted in the FLX group , whereas in the 4-AP group higher basal fatigability test scores were associated with greater reduction in fatigue scores
While no clinical trial to date has specifically targeted fatigue , r and omized controlled trials , systematic review s , and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue .
Fatigue is a disabling , multifaceted symptom that is highly prevalent and stubbornly persistent .
Although fatigue is a frequent complaint among patients with fibromyalgia , it has not received the same attention as pain .
Reasons for this include lack of st and ardized nomenclature to communicate about fatigue , lack of evidence -based guidelines for fatigue assessment , and a deficiency in effective treatment strategies .
Fatigue does not occur in isolation ; rather , it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain , unrefreshing sleep , anxiety , depression , cognitive difficulties , and so on .
Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms .