Chronic widespread pain and fatigue, not related to a medical condition, may be explained by concurrent anxiety and depression, a new study reported, indicating that clinicians need to be attentive to mental health to provide optimal care.
Widespread and chronic pain and fatigue often go hand-in-hand and share several risk factors, such as depression and anxiety, which is overrepresented among these patients. Researchers at the University of Manchester explored these factors in a large population-based study of people registered at two general practices in North West England.
To assess potential influences of socioeconomic character, patients at clinics in two different areas — one an affluent rural area, and one an inner-city area — were targeted.
Among 2,985 individuals contacted, 2,490 were eligible to participate in the study. The potential participants, ages 25–65, were sent a questionnaire assessing the presence of chronic widespread pain, chronic fatigue, and other factors such as sociodemographic issues, general health, healthcare use, childhood factors, adult attachment, and psychological stress such as anxiety and depression.
To explore if pain and fatigue could be linked to any medical conditions, the study, “Common and unique associated factors for medically unexplained chronic widespread pain and chronic fatigue,“ also analyzed medical records of consenting participants. Medical conditions during a period of one year before the first questionnaire to one year after were examined.
Findings, published in the Journal of Psychosomatic Research, showed that among the final 990 participants, 9.4 percent had chronic widespread pain that could not be explained by an underlying medical condition. An additional 12.6 percent had similarly unexplained chronic fatigue.
A multitude of factors were found to be common both in individuals with chronic pain and fatigue, such as marital status (separated, widowed or divorced), unemployment, childhood psychological or physical abuse, recent threatening experiences, and other medical symptoms.
Other factors were not shared, and the study showed that low education levels and other medical conditions tended to be present only in individuals with chronic pain, while illness or injury in a close relative, as well as anxiety and depression, were mainly linked to fatigue.
Factors common to pain and fatigue occurred more frequently in individuals who also had anxiety or depression, compared to individuals with pain and fatigue but no mental health issues, the study reported. Also, among the factors unique to pain or fatigue, the presence of depression and anxiety was overrepresented, indicating that the association between pain or fatigue and a certain risk factor was more likely a result of anxiety or depression.
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