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

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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