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The aetiopathogenesis of fatigue: unpredictable, complex and persistent

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By James E. Clark et al.
 
Abstract
 
Background: Chronic fatigue syndrome is a common condition characterized by severe fatigue with post-exertional malaise, impaired cognitive ability, poor sleep quality, muscle pain, multi-joint pain, tender lymph nodes, sore throat or headache. Its defining symptom, fatigue is common to several diseases.
 
Areas of agreement: Research has established a broad picture of impairment across autonomic, endocrine and inflammatory systems though progress seems to have reached an impasse.
 
Areas of controversy: The absence of a clear consensus view of the pathophysiology of fatigue suggests the need to switch from a focus on abnormalities in one system to an experimental and clinical approach which integrates findings across multiple systems and their constituent parts and to consider multiple environmental factors.
 
Growing points: We discuss this with reference to three key factors, non-determinism, non-reductionism and self-organization and suggest that an approach based on these principles may afford a coherent explanatory framework for much of the observed phenomena in fatigue and offers promising avenues for future research.
 
Areas timely for developing research: By adopting this approach, the field can examine issues regarding aetiopathogenesis and treatment, with relevance for future research and clinical practice.
 
Source: James E. Clark, W. Fai Ng, Stuart Watson and Julia L. Newton. The aetiopathogenesis of fatigue: unpredictable, complex and persistent.Br Med Bull (2016) doi: 10.1093/bmb/ldv057 First published online: February 12, 2016

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