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Chronic Fatigue Syndrome and Chronic Widespread Pain in Adolescence: Population birth cohort study.

RogerBlack

Senior Member
Messages
902
https://www.ncbi.nlm.nih.gov/pubmed/27845196

Crawley et al.
Unfortunately, questionnaire based from a general purpose survey, so at best would be an interesting screen to use before contacting the patients and following them up to see if they have CFS. This was not done, nor were the questions specific to CFS. At best perhaps an upper bound on those who have fatigue and some other symptoms.

We identified 3214 adolescents with complete data for all outcomes and covariates. There were 82 (2.6%) individuals classified as CFS and 145 (4.5%) as CWP. A classification of CFS resulted in an increased likelihood of having CWP (OR: 3.87; 95% CI: 2.05 - 7.31). Females were approximately twice as likely to have CFS or CWP, with multinomial regression revealing a greater sex-effect for CWP compared to CFS. Those with exclusive CFS were more likely to report higher levels of pain and greater effect of pain compared to those without CFS, though associations attenuated to the null after adjustment for covariates, which did not occur in those with exclusive CWP. Multinomial regression revealed that relative to having neither CFS nor CWP, a one-unit increase in the depression and anxiety scales increased the risk of having exclusive CFS and, to a greater extent, the risk of having co-morbid CFS and CWP, but not exclusive CWP, which was


Participants were classified as CFS if they indicated that they had been getting tired or had been lacking in energy during the past month and then responded ‘yes’ to >2 of the following 4 items: 1) felt tired or lacking in energy for 4 days or more in the past 7 days, 2) felt tired or lacking in energy for more than 3 hours in total on any day in the past 7 days, 3) felt so tired or lacking in energy that they had to push themselves to get things done on 1 or more occasion in the past 7 days, and 4) felt tired or lacking in energy when doing things they enjoy in the past 7 days. Participants were classified as not chronically fatigued if: the tiredness or lack of energy had lasted for <6 months, the adolescent thought it was due to exercise or medication, the adolescent felt better after resting, if daily activities were not impaired, or if exercise did not make them feel exhausted the following day. The CIS-R also provided data on 9 of the 12 associated symptoms of CFS listed in NICE guidelines,39 namely: muscle or joint pain, headaches, painful glands, sore throat, problems with memory or concentration (cognitive dysfunction), dizziness, nausea, and insomnia (as part of the ‘difficulty sleeping’ symptom in the NICE guideline). Adolescents without any of these accompanying symptoms were reclassified as non-CFS. Because data on only 9 of the 12 symptoms included in the NICE guideline could be collected using the CIS-R, the estimates of CFS at 17 years are likely to be conservative (ie, an adolescent may have been classified as non-CFS because of the lack of 1 of the 9 symptoms, but he/she may have had 1 of the other 3 symptoms for which data were uncollected). Of those identified as having CFS, 16.5% had a single symptom, 29.13% had 2, 25.54% had 3, 10.68% had 4, 8.74% had 5, 5.83% had 6, 2.91% had 7, and .97% had 8. Adolescents were classified as non-CFS if they reported having had problems with alcohol or drugs (crack, solvents, heroin, or cocaine) during the previous year, or a diagnosis of anorexia nervosa.

The prevalence of 2.6% seems rather high, though the case definition is a hell of a lot better than '6 months medically unexplained fatigue'.
As an exclusion 'the adolescent felt better after resting' seems to partially capture PEM and non-restorative sleep.

The lack of support they find for the central sensitisation hypothesis is interesting - as I understand it this is one of the keystones of BPS.
(everything is felt more than it should, so fear/avoidance kick in)
 
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A.B.

Senior Member
Messages
3,780
At the same research clinic, a computer-based Revised Clinical Interview Schedule (CIS-R) was filled out, from which a classification of CFS was obtained.

The diagnosis of CFS was based on a questionnaire for "measuring psychiatric disorders" (see link). There is no mention of medical investigation.

https://www.ncbi.nlm.nih.gov/pubmed/1615114
 
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Cinders66

Senior Member
Messages
494
"Future research should investigate whether depression and anxiety are causal or secondary to CFS and whether anxiety is causal for chronic pain syndrome. Furthermore, it is important to elucidate the factors that are contrib- uting to the higher prevalence of CFS, and to a greater degree, CWP, observed in women [/QUOTE]


You could think the NICE criteria were developed especially for people like Crawley to endlessly approach CFS from a MH/behavioural perspective
 
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Messages
13,774
The prevalence of 2.6% seems rather high, though the case definition is a hell of a lot better than '6 months medically unexplained fatigue'.
As an exclusion 'the adolescent felt better after resting' seems to partially capture PEM and non-restorative sleep.

I agree. Maybe they used looser cut-offs than normal for other things?

The lack of support they find for the central sensitisation hypothesis is interesting - as I understand it this is one of the keystones of BPS.
(everything is felt more than it should, so fear/avoidance kick in)

Thanks for pointing that out interesting.
 

Cinders66

Senior Member
Messages
494
"Future research should investigate whether depression and anxiety are causal or secondary to CFS and whether anxiety is causal for chronic pain syndrome. Furthermore, it is important to elucidate the factors that are contrib- uting to the higher prevalence of CFS, and to a greater degree, CWP, observed in women."


Think we can guess these won't be the factors that cause higher prevalence in autoimmune illness?
 

TiredSam

The wise nematode hibernates
Messages
2,677
Location
Germany
The lack of support they find for the central sensitisation hypothesis is interesting - as I understand it this is one of the keystones of BPS.

Allow me to introduce ... the keystones of BPS:

keystones.jpg
 

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
The diagnosis of CFS was based on a questionnaire for "measuring psychiatric disorders" (see link). There is no mention of medical investigation.

https://www.ncbi.nlm.nih.gov/pubmed/1615114
A medical examination is mandatory for diagnosing CFS according to Fukuda, NICE or Canadian criteria - all of them. It's mandatory because there are so many possible alternative causes of fatigue that you can't find with a questionnaire. So this study tells us nothing useful about CFS, however defined. Publish it as a chronic fatigue study perhaps, but researchers and journals shouldn't use the CFS label without proper CFS diagnosis.
 

PhoenixDown

Senior Member
Messages
456
Location
UK
Participants were classified as CFS if they indicated that they had been getting tired or had been lacking in energy during the past month and then responded ‘yes’ to >2 of the following 4 items: 1) felt tired or lacking in energy for 4 days or more in the past 7 days, 2) felt tired or lacking in energy for more than 3 hours in total on any day in the past 7 days, 3) felt so tired or lacking in energy that they had to push themselves to get things done on 1 or more occasion in the past 7 days, and 4) felt tired or lacking in energy when doing things they enjoy in the past 7 days.
That doesn't sound like M.E to me, sounds more like chronic fatigue, yet another case of diluted definitions, typical Esther Crawley.
 

RogerBlack

Senior Member
Messages
902
I guess on reflection (first post edited) that this would be a reasonable upper bound on CFS in the population.
But not an actually useful one, as nobody thinks it's that high.
 
Messages
13,774
It's only asking about the past 7 days, so it wouldn't even qualify as vaguely being "chronic".

I think I'd just assumed there must be something to indicate more long-standing problems! If it really is just about the last seven days, that's ridiculous.
 

Large Donner

Senior Member
Messages
866
RogerBlack said:
Participants were classified as CFS if they indicated that they had been getting tired or had been lacking in energy during the past month and then responded ‘yes’ to >2 of the following 4 items: 1) felt tired or lacking in energy for 4 days or more in the past 7 days, 2) felt tired or lacking in energy for more than 3 hours in total on any day in the past 7 days, 3) felt so tired or lacking in energy that they had to push themselves to get things done on 1 or more occasion in the past 7 days, and 4) felt tired or lacking in energy when doing things they enjoy in the past 7 days.



That doesn't sound like M.E to me, sounds more like chronic fatigue, yet another case of diluted definitions, typical Esther Crawley.


Sounds more to me like confused teenagers being asked if they slowed down near their bedtime a bit or switched of a bit during a boring lesson or were recovering from a sports event the previous day.

Its a really serious problem this, being tired leading up to bedtime 3 days out of seven. Thank goodness people like Crawley are on the case, we need to throw as much money at this as possible whilst ignoring neuro immune diseases.
 
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ash0787

Senior Member
Messages
308
A lot of the research I am seeing here is like this, this one seems to be bordering on 'social science', very sad

" Furthermore, it is important to elucidate the factors that are contrib- uting to the higher prevalence of CFS, and to a greater degree, CWP, observed in women " most likely natural selection, you know that basic principle of science ?