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The persistence of fatigue in Chronic Fatigue Syndrome (CFS) & multiple sclerosis (MS): development of a model

  [ 117 votes ]   [ Discuss This Article ]
By Vercoulen JH, Swanink CM, Galama JM, Fennis JF, Jongen PJ, Hommes OR, van der Meer JW, Bleijenberg G • www.ProHealth.com • December 5, 1998


The cause of chronic fatigue syndrome (CFS) is unknown. With
respect to factors perpetuating fatigue, on the other hand, a
model has been postulated in the literature in which
behavioral, cognitive, and affective factors play a role in
perpetuating fatigue. In the present study, this hypothesized
model was tested on patients with CFS and on fatigued patients
with multiple sclerosis (MS). The model was formulated in
terms of cause-and-effect relationships and an integral test
of this model was performed by the statistical technique,
"structural equation modeling," in 51 patients with chronic
fatigue syndrome and 50 patients with multiple sclerosis
matched for age, gender, and education. Attributing complaints
to a somatic cause produced low levels of physical activity,
which in turn had a causal effect on fatigue severity.
Depression had to be deleted from the model. Sense of control
over symptoms and focusing on bodily symptoms each had a
direct causal effect on fatigue. The model showed an excellent
fit for CFS patients, but was rejected for MS patients.
Therefore, a new model for MS patients had to be developed in
which sense of control had a causal effect on fatigue. In the
MS model, no causal relationship was found between the
physical state as measured by the Expanded Disability Status
Score (EDSS) and fatigue or functional impairment. The present
study shows that cognitive and behavioral factors are involved
in the persistence of fatigue. Treatment should be directed at
these factors. The processes involved in the subjective
experience of fatigue in CFS were different from the processes
related to fatigue in MS.




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