Pain and Depression Are Associated With More Anxiety in ME/CFS: A Cross-Sectional Cohort Study Between Norway and Spain

Abstract

Objectives: Lasting, unexplained and high levels of pain may cause anxiety in patients with chronic fatigue syndrome. The objectives of the current study were to test assumptions of the association between pain and anxiety in patients diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and to clarify the role of depression in this relationship. Methods: Data were collected from 664 participants (age 18-65 years) with 133 ME/CFS patients and 201 healthy controls from Norway and 330 CFS patients from Spain. Binary logistic regression model was applied to test relationships between the included variables in the samples. Results: Both pain and depression made significant direct contributions to the level of anxiety. The strongest risk for higher levels of anxiety was the combination of high levels of depression and high levels of pain in the overall sample (OR = 49.70; P < 0.001), not so much in the Spanish cohort (OR = 11.99; P < 0.0001) and most of all in the Norwegian cohort (OR = 88.21; P < 0.001) sample. Conclusions: It was the combination of high pain levels and high levels of depression that to the greatest extent increased the risk of anxiety in patients with CFS/ME. Whatever diagnostic criterion that is applied, anxiety and depression should be mandatory to assess in the clinical assessments performed for diagnosing the ME/CFS. Approaches addressing anxiety-related pain and treatment of depression should be warranted.

Long-term health outcomes of Q-fever fatigue syndrome patients

“…However, the comparison rates used were also assessed during the COVID-19 pandemic, though one year earlier (April–May 2020) [28]. Similar to other patient populations, depression and anxiety frequently co-occurred in QFS patients; over half of the patients in our study who had a score indicative of depression also had a score indicative of anxiety [31].…”

Assessing sleep and pain among adults with myalgic encephalomyelitis/chronic fatigue syndrome: psychometric evaluation of the PROMIS® sleep and pain short forms

“…Importantly, other than fatigue, pain has been identified as the most troublesome ME/CFS symptom, with 65% of severely ill patients identifying pain as the top three most troublesome [ 14 ]. Among people with ME/CFS, research found that pain was associated with reduced functioning and quality of life [ 41 ]; if accompanied with depression, pain was also associated with anxiety [ 42 ]. Several measures have been used in clinical settings to evaluate ME/CFS pain [ 43 – 49 ]; however, such measures often focus on the frequency and severity of pain [ 37 ], while the specific consequences of pain on daily functioning and interference with life have not been fully assessed.…”

Chronic Pain and Mood Disorders in Asian Americans

“…The prevalence of chronic pain among adults seen in the primary care setting ranged between 10% and 15% (Nahin, 2015). Mood disorders, including depression and anxiety disorders, are also common health issues in primary care settings (Gold et al, 2020;Strand, Castro-Marrero, Helland, Alegre, & Mengshoel, 2020). Up to 14% of patients seen in primary care have estimated to have depression (Gonzalez et al, 2010).…”