Tired all the time: can new research on fatigue help clinicians?

Harvey, Samuel B; Wessely, Simon

doi:10.3399/bjgp09x420284

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…There are numerous cautionary tales of individuals who have suffered from delayed or missed diagnoses of serious illnesses due to under investigating of fatigue [ 9 ]. Yet if the search for unlikely 'zebra' causes of fatigue goes on too long, the risk of iatrogenic harm increases and the opportunity for early focused treatment of CFS may be lost [ 10 ].…”

Section: Commentarymentioning

confidence: 99%

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Chronic fatigue syndrome: identifying zebras amongst the horses

Harvey

Wessely

2009

BMC Med

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There are currently no investigative tools or physical signs that can confirm or refute the presence of chronic fatigue syndrome (CFS). As a result, clinicians must decide how long to keep looking for alternative explanations for fatigue before settling on a diagnosis of CFS. Too little investigation risks serious or easily treatable causes of fatigue being overlooked, whilst too many increases the risk of iatrogenic harm and reduces the opportunity for early focused treatment. A paper by Jones et al published this month in BMC Medicine may help clinicians in deciding how to undertake such investigations. Their results suggest that if clinicians look for common psychiatric and medical conditions in those complaining of prolonged fatigue, the rate of detection will be higher than previously estimated. The most common co-morbid condition identified was depression, suggesting a simple mental state examination remains the most productive single investigation in any new person presenting with unexplained fatigue. Currently, most diagnostic criteria advice CFS should not be diagnosed when an active medical or psychiatric condition which may explain the fatigue is identified. We discuss a number of recent prospective studies that have provided valuable insights into the aetiology of chronic fatigue and describe a model for understanding chronic fatigue which may be equally relevant regardless of whether or not an apparent medical cause for fatigue can be identified.See the associated research paper by Jones et al: http://www.biomedcentral.com/1741-7015/7/57 CommentaryMedical students are often told that the sound of approaching hooves is more likely to herald the arrival of horses than zebras. The metaphor reinforces the idea that in medicine common things happen commonly and that clinicians should avoid spending too much time chasing rare or unlikely diagnoses. Fatigue is a very common clinical problem with many possible causes [1,2]. Some causes of fatigue are common 'horses' such as anaemia, viral infections, sleep deprivation, diabetes and depression. However, potential 'zebras' such as malignancy or auto-immune disorders may also present with fatigue. Even with extensive investigations, the underlying aetiology of an individual's fatigue in many cases remains unknown. Over recent decades there has been increasing recognition of a group of individuals with severe, persistent, and unexplained fatigue [3]. Such persistent fatigue has, at times, been seen as an illness of modern life, although there is good evidence to show that chronic fatigue has been a common problem since at least the 19th century, but under different diagnostic labels, such as neurasthenia [4,5]. Some, but by no means all, of these individuals fulfil the current criteria for chronic fatigue syndrome (CFS), which requires that persisting or relapsing fatigue be present for at least 6 months, is not relieved by rest, is not explained by medical or psychiatric condi-

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Section: Commentarymentioning

confidence: 99%

“… Proposed model for understanding the aetiology of chronic fatigue syndrome (CFS) [ 10 , 16 , 19 , 22 - 28 , 32 - 34 ]. …”

Section: Commentarymentioning

confidence: 99%

Chronic fatigue syndrome: identifying zebras amongst the horses

Harvey

Wessely

2009

BMC Med

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“…Porta (78), Lahelma (79) y Siegrist (80), en cambio, mencionan tres conceptos diferentes de enfermedad, pero desde una perspectiva fisiológica (disease), psicológica (illness) y socialmente percibida tanto por el sujeto afectado como por la sociedad (sickness/ disability). Durante décadas se ha tratado de achacar el agotamiento profesional al estrés laboral, al "sufrimiento mental", a la "fatiga por compasión" (81) o al "cansancio a toda hora" (82)(83)(84). El agotamiento profesional va más allá de la noción de riesgo, ergo, más allá de lo que la epidemiología plantea, es decir, "el estudio de los factores de riesgo o de protección que afectan la salud de una población y su modo de prevenirlos o promoverlos", aun cuando esto resulte ser de vital importancia para la salud pública en la actualidad.…”

Section: Agotamiento Profesional Mucho Más Que Un Síndromeunclassified

Agotamiento profesional (burnout): concepciones e implicaciones para la salud pública

Segura

2014

biomedica

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El agotamiento profesional (burnout) se describió originalmente como una condición mental caracterizada por disminución del desempeño laboral, sensación de impotencia y frustración e incapacidad para alcanzar objetivos o metas laborales. Para algunos autores, el agotamiento profesional es un conjunto de signos y síntomas mal definido, en tanto que para otros es una enfermedad en sí misma y un problema potencial de salud pública. Se ha observado en todo el mundo que los profesionales y técnicos más afectados son aquellos que prestan servicios o asisten a otras personas, especialmente los dedicados a la atención en salud. Este ensayo se centra en la idea de que el agotamiento profesional debe ser asumido como una enfermedad más que como un síndrome; que sus referentes teóricos y metodológicos han variado a medida que han cambiado las definiciones de salud y enfermedad; que se detecta y se reporta cada vez más, y que sigue siendo una condición objeto de debate en diversos círculos científicos donde se esgrimen posturas radicalmente opuestas que son materia de análisis aquí. Tras exponer las diversas concepciones en torno a esta condición, el ensayo concluye con la exposición de las implicaciones y las opciones de estudio del agotamiento profesional como enfermedad en función de las condiciones y los entornos que favorecen su aparición entre los profesionales dedicados a la salud.Palabras clave: agotamiento profesional, salud pública, epidemiología, conocimiento, investigación en los servicios de salud, vigilancia de la salud del trabajador.

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“…Fatigue lasting more than 1 month is reported by 10-24% of attendees in general practice [1][2][3]. The population prevalence of chronic fatigue syndrome/myalgic encephalopathy (CFS/ME), where fatigue has persisted beyond 4 months, is 0.2-2%.…”

Section: Introductionmentioning

confidence: 99%

The feasibility and acceptability of an early intervention in primary care to prevent chronic fatigue syndrome (CFS) in adults: randomised controlled trial

O’Dowd

Beasant

Ingram

et al. 2020

Pilot Feasibility Stud

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Background: Chronic fatigue syndrome (CFS, also known as myalgic encephalomyelitis (ME)) is defined as fatigue that is disabling, is accompanied by additional symptoms and persists for ≥ 4 months. Treatment of CFS/ME aims to help patients manage their symptoms and make lifestyle adjustments. We do not know whether intervening early in primary care (< 4 months after onset of fatigue) can prevent the development of CFS/ME. Methods: This was a feasibility randomised controlled trial with adults (age ≥ 18 years) comparing usual care with usual care plus an early intervention (EI; a combination of psycho-education and cognitive behavioural therapy, CBT). This study took place in fourteen primary care practices in Bristol, England and aimed to identify issues around recruitment and retention for a full-scale trial. It was not powered to support statistical analysis of differences in outcomes. Integrated qualitative methodology was used to explore the feasibility and acceptability of recruitment and randomisation to the intervention. Results: Forty-four patients were recruited (1 August 2012-November 28, 2013), falling short of our predicted recruitment rate of 100 patients in 8 months. Qualitative data from GPs showed recruitment was not feasible because it was difficult to identify potential participants within 4 months of symptom onset. Some referring GPs felt screening investigations recommended by NICE were unnecessary, and they had difficulty finding patients who met the eligibility criteria. Qualitative data from some participant interviews suggested that the intervention was not acceptable in its current format. Although the majority of participants found parts of the intervention acceptable, many reported one or more problems with acceptability. Participants who discontinued the intervention or found it problematic did not relate to the therapeutic model, disliked telephone consultations or found self-reflection challenging. Conclusions: A randomised controlled trial to test an early intervention for fatigue in adults in primary care is not feasible using this intervention and recruitment strategy.

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Tired all the time: can new research on fatigue help clinicians?

Cited by 8 publications

References 26 publications

Chronic fatigue syndrome: identifying zebras amongst the horses

Chronic fatigue syndrome: identifying zebras amongst the horses

Agotamiento profesional (burnout): concepciones e implicaciones para la salud pública

The feasibility and acceptability of an early intervention in primary care to prevent chronic fatigue syndrome (CFS) in adults: randomised controlled trial

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