The role of fatigue in functional outcomes for youth with chronic pain

Abstract

Background As a complex multidimensional construct, fatigue may play an important role in the physical and psychosocial functioning of youth with chronic pain. Based on a model previously tested in adults, the current study similarly utilized patient‐reported outcomes measurement system (PROMIS) to examine how fatigue contributes to functional outcomes for youth with chronic pain. The model tested self‐reported ratings of pain intensity, depressive symptoms and sleep disturbance as predictors of outcomes (mobility, pain‐related interference and school functioning) as mediated by ratings of fatigue. Methods Two hundred and eighty‐five youth with chronic pain ages 8–17 years and their caregivers, completed surveys as part of their initial clinical evaluation at a tertiary paediatric pain clinic. Study measures included: paediatric PROMIS domains (mobility, pain interference, sleep disturbance, fatigue and depressive symptoms), Paediatric Quality of Life school functioning and pain intensity. All mediated effects were calculated via a 1,000‐draw bootstrap estimation method in Mplus. Results Fatigue was found to be a statistically significant mediator of the effects of pain intensity, sleep disturbance and depressive symptoms on outcomes of pain interference, mobility and school functioning. While pain intensity was found to independently contribute to mobility and pain interference, depressive symptoms did not show significant effects on any outcome beyond its association with fatigue. Sleep disturbance predicted pain interference while fatigue predicted school functioning. Conclusions Findings suggest that fatigue is an important intervening factor for functional outcomes among youth with chronic pain. Targeting fatigue may be effective in optimizing school functioning and reducing the deleterious effects of depressive symptoms. Significance This cross‐sectional study highlights fatigue as a potential clinical target by applying a path analytic model to understand its possible significance and distinction from overlapping constructs such as pain intensity, depression and sleep disturbance. Further study of fatigue may be important in understanding its importance in treatment of paediatric chronic pain.

The prevalence of fatigue among Chinese nursing students in post-COVID-19 era

“…The relationship between fatigue and depression/anxiety were bidirectional (Thorsteinsson et al, 2019) (i.e., fatigue could increase the risk of depression and anxiety, and vice versa). Consistent with previous findings (Kaasa et al, 1999;Yoon et al, 2019), in this study more severe pain was associated with a higher risk of fatigue in nursing students. Pain is defined as an unpleasant sensory and emotional experience usually associated with actual or potential tissue damage (Raja et al, 2020) caused by internal and/or external factors (e.g., cold, heat, physical pressure and lesions).…”

Assessing fatigue in children and adolescents: Psychometric validation of the German version of the PROMIS® Pediatric Short Form v2.0 - Fatigue 10a in school children and pediatric chronic pain patients

“…In general, the fatigue scores in both German samples were rather low compared to the previous research [5,16]. On average, both students and patients reported the occurrence of fatigue symptoms as "almost never."…”

“…Only less than 2% of patients reported fatigue symptoms "often" to "almost always." In a previous study, using the English version of the PROMIS ® F-SF, pediatric chronic pain patients had T-scores on average 10 points higher than those of the patients in the present study [16].…”

“…Fatigue has a negative impact on health outcomes in children and adolescents including sleep disturbances, impaired social relationships, school absence, anxiety, depression, and poorer quality of life [3,5]. The negative effects of fatigue are not only seen in healthy children, children with pre-existing health problems, such as recurrent pain, also struggle with the impact of fatigue on their daily life, including sleep disturbances and reduced HRQoL [3,[9][10][11][12][13][14][15][16]. Previous research also shows that fatigue negatively impacts pain characteristics such as pain intensity [12,16], functional disability [16], and pain-related school absenteeism [11,16,17].…”

Depression, anxiety, and loneliness among adolescents and young adults with IBD in the UK: the role of disease severity, age of onset, and embarrassment of the condition

“…Such findings suggest that the management of pain could reduce mental ill-health for those with IBD. However, there may be mechanisms at work that were not examined in the current study: given that pain is associated with chronic fatigue in many diseases among AYA [48,49], and fatigue is associated with depressive symptoms in patients [50,51], the management of pain, because it is associated with fatigue, could reduce mental ill-health for those with IBD. The examination of the role of fatigue in the prospective relationship between pain and mental ill-health in AYA with IBD should be a focus of future work.…”