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Common & unique associated factors for medically unexplained chronic widespread pain & chronic fatig

Dolphin

Senior Member
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17,567
Free: http://www.jpsychores.com/article/S0022-3999(15)00556-5/fulltext
Common and unique associated factors for medically unexplained chronic widespread pain and chronic fatigue.
McBeth J1, Tomenson B2, Chew-Graham CA3, Macfarlane GJ4, Jackson J5, Littlewood A6, Creed FH5.
Author information

J Psychosom Res. 2015 Dec;79(6):484-91. doi: 10.1016/j.jpsychores.2015.10.004. Epub 2015 Oct 19.

Abstract
OBJECTIVE:
Chronic widespread pain and chronic fatigue share common associated factors but these associations may be explained by the presence of concurrent depression and anxiety.

METHODS:
We mailed questionnaires to a randomly selected sample of people in the UK to identify participants with chronic widespread pain (ACR 1990 definition) and those with chronic fatigue. The questionnaire assessed sociodemographic factors, health status, healthcare use, childhood factors, adult attachment, and psychological stress including anxiety and depression. To identify persons with unexplained chronic widespread pain or unexplained chronic fatigue; we examined participant's medical records to exclude medical illness that might cause these symptoms.

RESULTS:
Of 1443 participants (58.0% response rate) medical records of 990 were examined. 9.4% (N=93) had unexplained chronic widespread pain and 12.6% (N=125) had unexplained chronic fatigue. Marital status, childhood psychological abuse, recent threatening experiences and other somatic symptoms were commonly associated with both widespread pain and fatigue. No common effect was found for few years of education and current medical illnesses (more strongly associated with chronic widespread pain) or recent illness in a close relative, neuroticism, depression and anxiety scores (more strongly associated with chronic fatigue). Putative associated factors with a common effect were associated with unexplained chronic widespread pain or unexplained chronic fatigue only when there was concurrent anxiety and/or depression.

DISCUSSION:
This study suggests that the associated factors for chronic widespread pain and chronic fatigue need to be studied in conjunction with concurrent depression/anxiety. Clinicians should be aware of the importance of concurrent anxiety or depression.

Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

KEYWORDS:
Chronic fatigue; Epidemiology; Fibromyalgia; Functional somatic syndromes; Medically unexplained symptoms; Population based

PMID:

26652592

PMCID:

PMC4678257

DOI:

10.1016/j.jpsychores.2015.10.004
[Indexed for MEDLINE]
 

Dolphin

Senior Member
Messages
17,567
Acknowledgements

We are grateful to the participants in the project and to the General Practitioners and their teams who facilitated it. The study was funded by the UK Medical Research Council ( G0500272 ). The UK MRC had no role in study design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
The Medical Research Council have in the past listed this study when mentioning funding it has given for CFS/ME. Cases of CFS/ME specifically were not sought in this study.
 

Dolphin

Senior Member
Messages
17,567
Chronic widespread pain

Participants were asked to report the presence of any musculoskeletal pain they had experienced in the past month,whether their pain had persisted for three months or more, and to shade on a four-view blank body manikin the location(s) of their pain. Using these data participants satisfying the criteria for chronic widespread pain included in the American College of Rheumatology 1990 criteria for fibromyalgia (pain above and below the waist, in the right and left hand sides of the body and in the axial skeleton, present for at least three months) [16] were identified.

Chronic fatigue

The fatigue scale contains 11 items that inquire about symptoms of physical and mental fatigue. Individual items are scored 0 or 1, with a total score ranging from 0 to 11. Participants with fatigue scores of 4 or more on the Fatigue Scale [17] and who had reported symptoms for six months or more were classified as having chronic fatigue.
 

Dolphin

Senior Member
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17,567
Prevalence of each symptom group

After exclusions because of missing data (chronic widespread pain [n = 5] or chronic fatigue [n = 6)]), 159 (11.1%) participants fulfilled criteria for chronic widespread pain and 229 (15.9%) had chronic fatigue. Of the 990 participants with medical record review, the prevalence figures were similar: 11.4% (n = 113, 95% CI 9.5 to 13.4) and 15.5% (n = 153, 95% CI 13.2 to 17.7) respectively, but 20 (17.7%) cases of chronic widespread pain and 28 (18.3%) cases of chronic fatigue could be attributed to a co-existing general medical illness. The prevalence of unexplained chronic widespread pain was 9.4% (n = 93, 95% CI 7.6 to 11.2), and chronic fatigue 12.6% (n = 125, 95% CI 10.6 to 14.7) and our analyses concerned these participants who fulfilled criteria for the unexplained symptom definitions. Mean SF-12 physical component scores were 42.4 (SD = 10.9) and 43.3 (SD = 11.8) for chronic widespread pain and chronic fatigue, respectively, indicating impaired health status.
These large percentages show that only a small percentage of the participants would have CFS.
 

Effi

Senior Member
Messages
1,496
Location
Europe
The Medical Research Council have in the past listed this study when mentioning funding it has given for CFS/ME. Cases of CFS/ME specifically were not sought in this study.
@Dolphin Do you mean that although this study doesn't talk about ME/CFS (just 'chronic fatigue'), it has on occasion been quoted in issues to do with ME/CFS?
 

Dolphin

Senior Member
Messages
17,567
http://www.meassociation.org.uk/201...pending-on-research-into-me-in-last-10-years/


Parliamentary Question: MRC spending on research into ME in last 10 years
Figures for the Medical Research Council’s research spend on ME over the last 10 years were released in a written answer by Minister for Universities and Science David Willetts yesterday.

He was answering a written question tabled by Ian Swales (Liberal Democrat MP for Redcar). The MP had asked the Secretary of State for Business, Innovation and Skills what estimate he has made of expenditure from the public purse on biomedical research relating to myalgic encephalomyelitis in each of the last 10 years.

Mr Willetts replied:

The Medical Research Council is one of the main agencies through which the Government support medical and clinical research. The MRC is an independent body which receives its grant in aid from the Department for Business, Innovation and Skills. The selection of projects for funding by MRC is determined through peer review.

“Biomedical” is not a category the MRC would normally use to classify research in its portfolio. In the last 10 years, MRC expenditure on research relating to CFS/ME was as follows:

£
2000/01 0
2001/02 0
2002/03 0
2003/04 141,000
2004/05 559,000
2005/06 752,000
2006/07 800,000
2007/08 1.35 million
2008/09 728,000
2009/10 109,000
Projects included within these figures are as follows:

Professor R K Morriss, university of Liverpool-Exploratory RCT of training general practitioners to manage patients with persistent medically unexplained symptoms (MUS).

Professor P White, Queen Mary College, London-The PACE trial; A RCT of CBT, graded exercise, adaptive pacing and usual medical care for the chronic fatigue syndrome.

Dr A Wearden, university of Manchester-Randomised controlled trial of nurse-led self-help treatment for primary care patients with chronic fatigue syndrome.

Dr K Bhui, Queen Mary College, London-Chronic Fatigue and Ethnicity.

Professor F H Creed, university of Manchester-The feasibility of a population-based study of CFS, IBS and CWP.

Dr C Clark, Queen Mary College, London-General and specific risk markers and preventive factors for chronic fatigue and irritable bowel syndromes.

Further information about most of these projects can be found on the MRC’s online research portfolio at:

http://www.mrc.ac.uk/ResearchPortfolio/index.htm


CFS/ME projects funded by the MRC: Those projects live from 1993/4
Start date
Principal Investigator
Project Title
Amount Awarded
1
01/06/2006
Professor K Bhui,
Queen Mary & Westfield College
Chronic fatigue and ethnicity
£162k
2
27/05/2008
Dr C Clark,
Centre for Psychiatry, Barts and The London School of Medicine
General and specific risk markers & preventive factors for chronic fatigue and irritable bowel syndromes
£367k
3
01/01/2006
Professor F Creed,
University of Manchester
The feasibility of a population based study of CFS, IBS and CWP
£118k

4
06/08/1997
Professor R K Morriss,
University of Manchester
The role of noradrenaline in the neuropsychological pathogenesis of the chronic fatigue syndrome
£37k
5
19/04/2004
Professor A J Weardon et al,
University of Manchester
Randomised controlled trial of nurse led self-help treatment for primary care patients with chronic fatigue syndrome
£743k
6
14/06/2004
Professor P D White et al,
Queen Mary & Westfield College
The PACE Trial: A RCT of CBT, graded exercise, adaptive pacing and usual medical care for the chronic fatigue syndrome
£2.07m
7
01/07/2003
Professor R Morriss,
University of Liverpool
Exploratory RCT of training GPs to manage patients with persistent medically unexplained symptoms
£356k
8
01/10/2004
Professor M Sharpe,
University of Edinburgh
A complex intervention for patients with medically unexplained symptoms in neurology clinics
£242k
9
01/01/1990
Professor A H Mann,
Institute of Psychiatry
An epidemiological approach to the study of chronic fatigue in primary care
£94.6k
(updated: June 2008)
 
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Dolphin

Senior Member
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17,567
The most prominent questionnaire used in this study is Hospital Anxiety and Depression Scale (HADS).
The Hospital Anxiety and Depression Scale (HADS) is a valid and reliable measure of anxiety and depression in the general population which avoids questions about physical symptoms (e.g. weight loss, pain) that might be caused by general medical illness [25]. A score of 11 or more indicates probable disorder for each dimension but a total HADS score (anxiety+depression) of 17+has been used also to detect probable depressive disorder [26].

Despite what they say, the questions are not necessarily perfect:


http://mediwikis.com/wiki/index.php/Hospital_Anxiety_and_Depression_Scale


Hospital Anxiety and Depression Scale
~ Scoring Sheet ~
Yes definitely
Yes sometimes
No, not much
No, not at all
1. I wake early and then sleep badly for the rest of the night.
3
2
1
0
2. I get very frightened or have panic feelings for apparently no reason at all.
3
2
1
0
3. I feel miserable and sad.
3
2
1
0
4. I feel anxious when I go out of the house on my own.
3
2
1
0
5. I have lost interest in things.
3 2
1 0
6. I get palpitations, or sensations of ‘butterflies’ in my stomach or chest.
3
2
1
0
7. I have a good appetite.
0 1
2 3
8. I feel scared or frightened.
3 2 1 0
9. I feel life is not worth living.
3 2
1 0
10. I still enjoy the things I used to.
0 1
2 3
11. I am restless and can’t keep still.
3 2 1 0
12. I am more irritable than usual.
3 2 1 0
13. I feel as if I have slowed down.
3 2
1 0
14. Worrying thoughts constantly go through my mind.
3
2
1
0

Anxiety 2, 4, 6, 8, 11, 12, 14
Depression 1, 3, 5, 7, 9, 10, 13
Scoring 3, 2, 1, 0 (For items 7 & 10 the scoring is reversed)
GRADING: 0 - 7 = Non-case 8 – 10 = Borderline case 11+ = Case
 

Hutan

Senior Member
Messages
1,099
Location
New Zealand
DISCUSSION:
This study suggests that the associated factors for chronic widespread pain and chronic fatigue need to be studied in conjunction with concurrent depression/anxiety. Clinicians should be aware of the importance of concurrent anxiety or depression.

Rather that should be:
'This study suggests that floundering around in a big pool of data with no good idea of who and what you are comparing muddies the waters.'
 

barbc56

Senior Member
Messages
3,657
If they cite the PACE trial, I would think that would invalidate much if not all of the study. However, unless the study is retracted others may not know the problems with PACE.

What a load of BS. I wonder how much money twas wasted spent on this study.

Maybe getting PACE retracted should be an advocacy goal or is that already happening and I missed it?

I've been having trouble keeping up with things as lately I can only focus for short periods of time.

Reading things like this are the real traumatic events in ones life!

Geese!
 
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Dolphin

Senior Member
Messages
17,567
If they cite the PACE trial, I would think that would invalidate much if not all of the study. However, unless the study is retracted others may not know the problems with PACE.

What a load of BS. I wonder how much money twas wasted spent on this study.

Maybe getting PACE retracted should be an advocacy goal or is that already happening and I missed it?
There's this:
http://www.virology.ws/2017/03/13/a...l-medicine-about-recovery-and-the-pace-trial/

An open letter to Psychological Medicine about “recovery” and the PACE trial

[..]

To protect patients from ineffective and possibly harmful treatments, White et al.’s recovery claims cannot stand in the literature. Therefore, we are asking Psychological Medicine to retract the paper immediately. Patients and clinicians deserve and expect accurate and unbiased information on which to base their treatment decisions. We urge you to take action without further delay.
 
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15,786
The most prominent questionnaire used in this study is Hospital Anxiety and Depression Scale (HADS).
Despite what they say, the questions are not necessarily perfect:
An Idiot's Guide to using the HADS:
  1. Is the respondent in the hospital?
    1. If not, don't use it.
  2. Is the respondent having all of their medical problems adequately treated?
    1. If not, don't use it.
  3. Does the respondent's medical issue only involve one system?
    1. If not, don't use it.
  4. Is the respondent receiving adequate assistance for their disabilities?
    1. If not, don't use it.
  5. Does the respondent only have an acute medical condition?
    1. If not, don't use it.
Seriously, what sort of moron mails a hospital questionnaire to people's homes? :confused:
 

Dolphin

Senior Member
Messages
17,567
Approximately 5% of participants with chronic widespread pain or chronic fatigue without concurrent anxiety and/or depression reported psychological abuse, which was similar to participants free of chronic widespread pain or chronic fatigue and significantly fewer than participants with these symptoms plus concurrent anxiety and/or depression (approximately 20%). A similar pattern was found with the other putative associated factors that had a common effect (Fig. 2a).

We found no association between reported childhood psychological abuse and chronic widespread pain or fatigue in the absence of anxiety or depression, suggesting that this is not a true associated factor for these symptom groups but only applicable when there is concurrent anxiety and/or depression [33,44,45]. This may explain why results concerning sexual abuse as a common associated factor for chronic fatigue syndrome are inconsistent [33,43,46].
 
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Dolphin

Senior Member
Messages
17,567
I'm suspicious of retrospective reporting of childhood abuse. I think getting ill can influence one's recollection of one's childhood. Also after becoming ill one could desperately search one's past to see what might have caused it. Also in my case when I'm feeling ill or in pain, it tends to churn up in my mind negative experiences from the past (even relatively mild ones) and I believe that happens with many other people also.
 

Snow Leopard

Hibernating
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5,902
Location
South Australia
I'm suspicious of retrospective reporting of childhood abuse. I think getting ill can influence one's recollection of one's childhood. Also after becoming ill one could desperately search one's past to see what might have caused it. Also in my case when I'm feeling ill or in pain, it tends to churn up in my mind negative experiences from the past (even relatively mild ones) and I believe that happens with many other people also.

Yes, exactly. Our society likes to find and blame "causes" for things, so those who are suffering from depression or anxiety are simply more likely to report childhood abuse as they perceive it as being a cause, whereas those who are not suffering from depression or anxiety are more likely to minimise any childhood abuse and thus not report it.

Many people don't like to discuss it, but childhood abuse, whether it be psychological abuse from parents, sexual, bullying etc is much more common than people realise.
 

Sean

Senior Member
Messages
7,378
I think getting ill can influence one's recollection of one's childhood.
As can not getting ill. Or getting married, or having children yourself, or...

Our society likes to find and blame "causes" for things, so those who are suffering from depression or anxiety are simply more likely to report childhood abuse as they perceive it as being a cause, whereas those who are not suffering from depression or anxiety are more likely to minimise any childhood abuse and thus not report it.
Exactly.
 

Effi

Senior Member
Messages
1,496
Location
Europe
discussion of research proving exactly that
I thought it was explained very well in this article: https://aeon.co/ideas/bad-thoughts-can-t-make-you-sick-that-s-just-magical-thinking
article said:
What’s more, memories of stressful events can be unreliable, especially if the recounting of such self-reported events is influenced by the expectations of researchers. Individuals or families who have suffered from an illness with uncertain or mysterious causes may be more likely to imagine a causal link with adverse life events.

A study in 1960, for example, found that parents of children with Down’s syndrome reported more ‘shocks’ during pregnancy than control subjects did. However, Down’s is a genetic disease that occurs at conception (though at the time of the study this had not yet been discovered).

Ironically, ‘healthy’ control subjects might tend to under-report adverse life experiences, and over-estimate their ability to control their circumstances. Sick people, on the other hand, are more likely to report adverse events, which are then incorrectly assumed by researchers to be directly relevant to the illness itself.
 
Messages
2,125
Maybe getting PACE retracted should be an advocacy goal or is that already happening and I missed it?
I've been calling on the #MM organisers to include a Retract PACE message in the upcoming protests but no one (apart from a couple of PR members) appear to be picking it up...........
http://forums.phoenixrising.me/index.php?posts/828408/
http://forums.phoenixrising.me/index.php?posts/833742/
http://forums.phoenixrising.me/index.php?posts/835805/

also emailed and got a reply from @L.A. Cooper but still no go.

I don't understand why.

Is it only people on PR (or those who have been ill for some time) who realise what a huge impact this might make on the status quo?