Korean Journal of Family Medicine

"Chronic Fatigue"

Original Article

Comparison of Fatigue Severity and Quality of Life between Unexplained Fatigue Patients and Explained Fatigue Patients: Eun Hae Yoo, Eun Sil Choi, Soo Hyun Cho, Jae Hyuk Do, Suk Jeong Lee, Jung-Ha Kim; Korean J Fam Med 2018;39(3):180-184. Published online May 18, 2018; DOI: https://doi.org/10.4082/kjfm.2018.39.3.180

Abstract
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Background
Recently, despite the high prevalence of fatigue in patients, there is a lack of research on the quality of life (QoL) in unexplained fatigue patients, indicating that they are not properly diagnosed and treated. The aim of this study was to compare fatigue severity and QoL between patients with explained and unexplained fatigue.
Methods
The study consisted of 200 Korean adults who complained of fatigue without underlying disease. Fatigue Severity Scale, Short Form Health Survey-36 version 2 (SF-36v2), and Beck Depression Inventory-II (BDI-II) selfquestionnaires were administered. Participants were dichotomized to two groups, namely, patients with unexplained or explained fatigue, sorted according to laboratory examination results. The chi-square test, t-test, and Wilcoxon rank-sum test were used, and analysis of covariance was calculated after adjusting for age, sex, body mass index, smoking status, and physical component summary (PCS) of SF-36v2 or BDI-II.
Results
PCS of SF-36v2 between the two groups showed significant difference. Compared to patients with explained fatigue, those with unexplained fatigue showed lower physical component scores of QoL.
Conclusion
QoL of patients with unexplained fatigue could largely diminish than those with explained fatigue. The primary clinician should be aware of poor QoL in patients with unexplained fatigue to identify who is in need of more attention and intervention.

Citations

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Prävention und Gesundheitsförderung.2024; 19(4): 567. CrossRef
Psychometric evaluation of the Arabic version of the fatigue 5-item measure (FM) among physiotherapy patients in Libya
Alhadi M. Jahan, Ali E. Rwaiha, Fatma A. Iqmeea
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Case Report

A Case of Incidentally Discovered Subclinical Cushing Syndrome in a Patient with Chronic Fatigue and Anxiety: Kyung-Jee Nam, Yun-Jin Kim, Sang-Yeoup Lee, Jeong-Gyu Lee, Young-Hye Cho, Yu-Hyun Lee, Eun-Jung Choi, Young-Jin Tak, Dong-Won Yi, Sung-Woo Park, Dong-Wook Jeong; Korean J Fam Med 2013;34(4):289-292. Published online July 24, 2013; DOI: https://doi.org/10.4082/kjfm.2013.34.4.289

Abstract
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Subclinical Cushing syndrome (SCS) is a hypothalamic-pituitary-adrenal axis abnormality characterized by autonomous cortisol secretion in patients with no typical signs or symptoms of Cushing syndrome. SCS patients may have adverse metabolic and cardiovascular effects due to slight, but continuous glucocorticoid secretion. Glucocorticoids also affect behavior, mood, neural activity, and a number of specific biochemical processes in the central nervous system. Here, we report a case of SCS due to an adrenal incidentaloma in a hypertensive diabetic patient who presented with chronic fatigue and anxiety that disappeared after the removal of the adrenal adenoma.

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Original Articles

Clinical Characteristics of Patients with Medically Unexplained Chronic Widespread Pain: A Primary Care Center Study: Kye Hwa Lee, Cheol Hwan Kim, Ho Cheol Shin, Eun Ju Sung; Korean J Fam Med 2011;32(5):277-284. Published online July 28, 2011; DOI: https://doi.org/10.4082/kjfm.2011.32.5.277

Abstract
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Background

Chronic widespread pain (CWP) is known as a common symptom of several organic and psychological disorders. Although medically unexplained CWP (MUE) has lots of clinical distress symptoms, there were no distinct symptoms or signs. Therefore, we conducted this study to investigate clinical distress symptoms of MUE distinct from those of medically explained CWP (ME).

Methods

One hundred nine patients with CWP were enrolled in the study. We classified the study subjects into three groups depending on their medical problems associated with CWP: organic group (ORG), psychological group (PSY), and MUE. All subjects were asked to fill out self-report questionnaires consisting of clinical distress scales including the Korean version of the Fibromyalgia Impact Questionnaire (FIQ-K), fatigue scale, depression scale, and stress scale. And physicians examined 18 tender points over their entire body of the subjects.

Results

MUE patients had higher FIQ-K and fatigue severity scores than ORG patients (all P < 0.05). The average number of tender points were 11.33 in MUE patients, 6.48 in ORG patients and 5.02 in PSY patients and statistically significant (P < 0.0001). There were no statistically different factors between MUE and PSY patients with exception for the number of tender points. Depressive symptom was the highest in PSY patients but not statistically different from MUE patients.

Conclusion

MUE patients had higher physical impairments, fatigue severity and more number of tender points than ORG patients, but had no different clinical characteristics from PSY patients except for the number of tender points.

Citations

Citations to this article as recorded by

The Effects of Forest Therapy on Coping with Chronic Widespread Pain: Physiological and Psychological Differences between Participants in a Forest Therapy Program and a Control Group
Jin-Woo Han, Han Choi, Yo-Han Jeon, Chong-Hyeon Yoon, Jong-Min Woo, Won Kim
International Journal of Environmental Research and Public Health.2016; 13(3): 255. CrossRef
Frequency of Counterstrain Tender Points in Osteopathic Medical Students
Karen T. Snider, John C. Glover, Paul R. Rennie, Heather P. Ferrill, William F. Morris, Jane C. Johnson
Journal of Osteopathic Medicine.2013; 113(9): 690. CrossRef
Neural and muscular dysfunction in fibromyalgia
Naglaa A. Gadallah, Mohamed R. Awad, Klaus R. von Wild, Hanan E. El-Hefnawy, Nadia H. El-Arousy, Nadia G. El-Hefnawy, Tarek A. Abdou, Ehab A. El Shafie, Abeer K. El Zohiery
Japanese Journal of Comprehensive Rehabilitation Science.2013; 4: 30. CrossRef

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3 Crossref

Fatigue Related Factors in Chronic Fatigue Patients with Chronic Widespread Pain after Treatment.: Cheol Hwan Kim, Ho Cheol Shin, Yong Woo Park, Eun Ju Sung; J Korean Acad Fam Med 2006;27(6):442-448. Published online June 10, 2006

Abstract
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Background
: The mechanism of fatigue in patients with fibromyalgia (FM) and CFS (CFS) has not been clarified, but recently there are opinions that chronic pain is a major factor causing chronic fatigue. We performed this study to identify major factors related to chronic fatigue.

Methods : The subjects were 37 patients aged over 18 who visited the primary care institute of a university hospital, whose major symptoms were chronic widespread pain and chronic fatigue and who were given the diagnosis of FM or CFS. The research was carried out through four weeks of symptomatic treatment. The correlation of fatigue severity with the intensity of pain, depression level and anxiety level was analyzed, and regression analysis was conducted to examine the relation between improvement of fatigue after the four weeks' treatment and changes in the intensity of pain, depression level and anxiety level.

Results : After the four week treatment, only the intensity of pain was significantly correlated with fatigue severity. In addition, only change in the intensity of pain was statistically significantly correlated with the improvement of fatigue.

Conclusion : In patients who complained of chronic fatigue and chronic widespread pain, the improvement of fatigue after treatment was related to the reduction of pain but not emotional factors such as depression and anxiety.

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Clinical characteristics and outcomes of fatigued patients in a university hospital based family practice, Korea..: Tae Kwan Kim, Jeong Hoon Ha, Do Whan Kim, Hoon Ki Park, Jung Kwon Lee; J Korean Acad Fam Med 1999;20(9):1129-1143. Published online September 1, 1999

Abstract
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Background
: Fatigue is one of the most common problems encountered in family practice but its diagnosis and management are neither standardized nor simplified. This baseline study was conducted to find out the clinical characteristics. clinical courses, and outcomes of fatigued patients.

Methods : This study included 163 fatigued patients who visited a department of a university hospital based family practice due to fatigue as their prima교 or secondary complaint. We classified fatigue which persisted for more than 6 months as chronic fatigue, less than 6 months as acute fatigue. Retrospective review of medical record was used to collect all related clinical all related clinical characteristics and telephone interview was done to follow the course and outcomes of fatigue.

Results : Of the total 163 fatigued patients, 105 patients(64.4%) were men. Fifty two patients(31.9%) visited the clinic for complete health check-up due to fatigue. The rate of response to telephone interview was 62.6%. Fifty five patients(33.7%) were acute fatigue, 75 patients(46.0%) chronic fatigue, and 33 patients(20.2%) unknown duration of fatigue. According to the causes of fatigue, 11.7% of patients corresponded to organic cause, 60.7% psychiatric cause, 27.6% unknown cause. Specified organic causes of fatigue, chronic hepatitis was the most common disease followed by alcohol liver disease, most common disease followed by alcohol liver disease, arthritis, anemia, viral syndrome and hyperthyroidism. As psychiatric causes of fatigue, stress was the most common cause followed by overwork, alcohol abuse, depression, and anxiety. Reassurance and observation(71.8%), drug therapy(17.8%) were the most common treatments. These who felt their function decreased below 50% were 7.6% of total 102 patients. On the survival analysis, 58.2% of acute fatigue patients, 62.4% of chronic fatigue patients, 67.0% of unknown patients had fatigue for 2 years since the initial visit.

Conclusion : As the cause of fatigue in a family practice, psychiatric causes were more frequent than organic causes. As psychiatric causes of fatigue, stress was the most common cause followed by overwork and alcohol abuse. Only one third of the third of the fatigued patients had improved two years later.

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An analysis of fatigue among outpatients.: Bang Bu Youn, Kyun Sang Lee, Hee Cheol kang, Kyung Kyun Shin; J Korean Acad Fam Med 1999;20(8):978-990. Published online August 1, 1999

Abstract
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Background
: Up to the present, there has been little study on chronic fatigue or chronic fatigue syndrome, and there is equally sparse relevant statistical data For this reason, we attempted to investigate the present status of fatigue, particularly its incidence and actual conditions.

Methods : The study subjects were 12,152 outpatients who visited family practice in hospitals all over Korea between July 24 and September 21,1997. They were given a questionnaire which included questions reflection the (U.S) Center for Disease Control criteria defining chronic fatigue syndrome.

Results : Among the subjects, 861 people complained of fatigue in their response to the questionnaire-re and they became the focus of the study. Of this fatigue group, 426 people(49.4%) had manifested fatigue for more than 6 months, and the male/female ratio was 54%/46%, respectively. People who re-ported that fatigue impaired their ability to function on a daily basis made up 35.8% of the fatigue group and the percentage of people who had considered visiting a clinic due to fatigue was an unexpectedly high 52.8%. The reported causes of fatigue, in decreasing order, were: social interactions(males 68.5%/females 45.1%); sleep disturbance(males 26.8%/females 21.8%); and physical maladies(males 24.2%/fe-mals 26.5%). There were significant gender differences in social interaction relating to domestic problems(males 4.7%/females 16.7%) and emotional problems(males 12.2%.femals 21.4%). Among 33 chronic fatigue syndrome patients who indicted what they thought were the causes of their problems, 68.8% reported physical maladies, 65.5% social life, 31.3% emotional problems, 21.9% sleep disturbance, and 21.9% domestic problems. The associated symptoms of fatigue reported in both males and females, in de-creasing order, included: myalgia, headache and neurological symptoms. The prevalence of chronic fatigue was 0.27%.

Conclusion : Our study showed that 7.1% of family practice outpatients complained of fatigue and that their daily activities or occupational life were disturbed as a result. This group demonstrates is serious need for medical assistance. Therefore, doctors should have more interest in fatigue, particularly in chronic fatigue syndrome, so as to provide real and versatile care.( J Korean Acad Fam Med 1999;20:978-990)

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Clinical characteristics of chronic fatigue and chronic fatigue syndrome in Korea.: Chel Hwan Kim, Ho Cheol Shin; J Korean Acad Fam Med 1998;19(12):1354-1367. Published online December 1, 1998

Abstract
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Background
: Chronic fatigue is a common symptom in primary care setting in Korea and classified into medically explained and unexplained according to the precipitating factors. The medically explained chronic fatigue may be associated with many well-known physical and psychological conditions and the medically unexplained chronic fatigue is classified into chronic fatigue syndrome and idiopathic chronic fatigue. The chronic fatigue syndrome is an illness that has unknown etiology and severe disabling fatigue and has been known to most physicians and public since mid-1980's. Many researches are ongoing in developed countries, although the pathophysiology and treatment of this syndrome are controversial. But in Korea, the researches for chronic fatigue and the chronic fatigue syndrome are very rare. Our goal was to assess the clinical characteristics of chronic fatigue and the chronic fatigue syndrome in Korea.

Methods : The study subjects were chronic fatigue patients visiting the chronic fatigue clinic in Kangbuk Samsung Hospital from Feb. 1, 1998 to Aug. 31, 1998. After medical history, physical examination, laboratory tests and questionnaire(including fatigue, anxiety and depression scales), the study subjects were classified into the medically explained(psychological disorder and physical disorder group) and unexplained chronic fatigue patient groups(the chronic fatigue syndrome group and idiopathic chronic fatigue group).

Results : The final study subjects were 97 patients(psychological disorder(20), physical disorder(20), idiopathic chronic fatigue(27), chronic fatigue syndrome(30)). Compared to the explained chronic fatigue group, unexplained chronic fatigue group had higher female ratio, lower body mass index, lower blood pressure, higher fatigue scale scores, and the higher prevalence of anxiety and insomnia.

Conclusion : From our results, unexplained chronic fatigue patients had higher fatigue severity and higher prevalence of anxiety and insomnia than the explained chronic fatigue patients. Although there are limitations to generalizing the results of this study(selection bias), it is significant in that it is the first study of the chronic fatigue syndrome in Korea.