Improvement in multiple dimensions of fatigue in patients with fibromyalgia treated with duloxetine: secondary analysis of a randomized, placebo-controlled trial A protocol and pilot study for managing fibromyalgia with yoga and meditation. The contribution of pain, reported sleep quality, and depressive symptoms to fatigue in fibromyalgia The relation of sleep difficulties to fatigue, mood and disability in chronic fatigue syndrome. The impact of a meditation-based stress reduction program on fibromyalgia. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities. Modafinil treatment for fatigue associated with fibromyalgia. What Makes Patients with Fibromyalgia Feel Better? Correlations Between Patient Global Impression of Improvement and Changes in Clinical Symptoms and Function: A Pooled Analysis of 4 Randomized Placebo-controlled Trials of Duloxetine The Symptoms of Advanced Cancer: Identification of Clinical and Research Priorities by Assessment of Prevalence and Severity Effects of muscle strengthening versus aerobic exercise program in fibromyalgia Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Randomized sham controlled trial of cranial microcurrent stimulation for symptoms of depression, anxiety, pain, fatigue and sleep disturbances in women receiving chemotherapy for early-stage breast cancer Mindfulness-Based Stress Reduction in Post-treatment Breast Cancer Patients: Immediate and Sustained Effects Across Multiple Symptom Clusters. A population-based study of the clinical course of chronic fatigue syndrome Non-recognition of depression and other non-motor symptoms in Parkinson's disease. Screening for the presence of FMR1 premutation alleles in women with fibromyalgia. A longitudinal study evaluating the effects of interferon-alpha therapy on cognitive and psychiatric function in adults with chronic hepatitis C. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Fatigue, not self-rated motor symptom severity, affects quality of life in functional motor disorders The relationship of cancer symptom clusters to depressive affect in the initial phase of palliative radiation. Mindfulness Meditation Alleviates Fibromyalgia Symptoms in Women: Results of a Randomized Clinical Trial Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy individuals. A mind-body technique for symptoms related to fibromyalgia and chronic fatigue.
Introduction Fatigue is one of the most disabling symptoms associated with fibromyalgia that greatly impacts quality of life . Fatigue was assessed as a secondary objective in a 2-phase , 24-week study in out patients with American College of Rheumatology-defined fibromyalgia . Methods Patients were r and omized to duloxetine 60 - 120 mg/d ( N = 263 ) or placebo ( N = 267 ) for the 12-week acute phase . At Week 12 , all placebo-treated patients were switched to double-blind treatment with duloxetine for the extension phase . Fatigue was assessed at baseline and every 4 weeks with the Multidimensional Fatigue Inventory ( MFI ) scales : General Fatigue , Physical Fatigue , Mental Fatigue , Reduced Activity , and Reduced Motivation . Other assessment s that may be associated with fatigue included Brief Pain Inventory ( BPI ) average pain , numerical scales to rate anxiety , depressed mood , bothered by sleep difficulties , and musculoskeletal stiffness . Treatment-emergent fatigue-related events were also assessed . Changes from baseline to Week 12 , and from Week 12 to Week 24 , were analyzed by mixed-effects model repeated measures analysis . Results At Week 12 , duloxetine versus placebo significantly ( all p < .05 ) reduced ratings on each MFI scale , BPI pain , anxiety , depressed mood , and stiffness . Improvement in ratings of being bothered by sleep difficulties was significant only at Weeks 4 and 8 . At Week 24 , mean changes in all measures indicated improvement was maintained for patients who received duloxetine for all 24 weeks ( n = 176 ) . Placebo-treated patients switched to duloxetine ( n = 187 ) had significant within-group improvement in Physical Fatigue ( Weeks 16 , 20 , and 24 ) ; General Fatigue ( Weeks 20 and 24 ) ; Mental Fatigue ( Week 20 ) ; and Reduced Activity ( Weeks 20 and 24 ) . These patients also experienced significant within-group improvement in BPI pain , anxiety , depressed mood , bothered by sleep difficulties , and stiffness . Overall , the most common ( > 5 % incidence ) fatigue-related treatment-emergent adverse events were fatigue , somnolence , and insomnia . Conclusions Treatment with duloxetine significantly improved multiple dimensions of fatigue in patients with fibromyalgia , and improvement was maintained for up to 24 weeks . Trial registration Clinical Trials.gov registry NCT00673452 Fibromyalgia is a chronic syndrome characterized by widespread pain , sleep disturbance , stiffness , fatigue , headache , and mood disorders . Recent research has result ed in an improved underst and ing of fibromyalgia and its possible causes . This article highlights some of the current research , discusses a strategy for using yoga and meditation as a therapy for fibromyalgia sufferers , and presents the results of a preliminary 8-week study using yoga and meditation to help manage fibromyalgia symptoms . The study of 11 participants found significant improvement in the overall health status of the participants and in symptoms of stiffness , anxiety , and depression . Significant improvements were also seen in the reported number of days " felt good " and number of days " missed work " because of fibromyalgia . Nonsignificant improvements were seen in measures of pain , fatigue , and how one felt in the morning . Effect sizes were medium to large for most tested areas . This study supports the benefits of yoga and meditation for individuals with fibromyalgia and encourages further research to explore their use as st and ard therapies for fibromyalgia & NA ; The major objective of this research was to evaluate the predictors of fatigue in patients with fibromyalgia ( FM ) , using cross‐sectional and daily assessment method ologies . In the cross‐sectional phase of the research involving a sample of 105 FM patients , greater depression and lower sleep quality were concurrently associated with higher fatigue . While pain was correlated with fatigue , it did not independently contribute to fatigue in the regression equation . For a subset of patients from the cross‐sectional sample ( n=63 ) who participated in a week of prospect i ve daily assessment of their pain , sleep quality , and fatigue , multiple regression analysis of aggregated ( averaged ) daily scores revealed that previous day 's pain and sleep quality predicted next day 's fatigue . Depression from the cross‐sectional phase was not related to aggregated daily fatigue scores . A path analytic framework was tested with disaggregated ( removing between subjects variability ) data in which pain was predicted to contribute to lower sleep quality which , in turn , was predicted to lead to greater fatigue . The results revealed that poor sleep quality fully accounted for the positive relationship between pain and fatigue , thus substantiating the mediational role of sleep quality . The findings are indicative of a dysfunctional , cyclical pattern of heightened pain and non‐restful sleep underlying the experience of fatigue in FM The relationship of sleep complaints to mood , fatigue , disability , and lifestyle was examined in 69 chronic fatigue syndrome ( CFS ) patients without psychiatric disorder , 58 CFS patients with psychiatric disorder , 38 psychiatric out- patients with chronic depressive disorders , and 45 healthy controls . The groups were matched for age and gender . There were few differences between the prevalence or nature of sleep complaints of CFS patients with or without current DSM-IIIR depression , anxiety or somatization disorder . CFS patients reported significantly more naps and waking by pain , a similar prevalence of difficulties in maintaining sleep , and significantly less difficulty getting off to sleep compared to depressed patients . Sleep continuity complaints preceded fatigue in only 20 % of CFS patients , but there was a strong association between relapse and sleep disturbance . Certain types of sleep disorder were associated with increased disability or fatigue in CFS patients . Disrupted sleep appears to complicate the course of CFS . For the most part , sleep complaints are either attributable to the lifestyle of CFS patients or seem inherent to the underlying condition of CFS . They are generally unrelated to depression or anxiety in CFS Fibromyalgia is a chronic illness characterized by widespread pain , fatigue , sleep disturbance , and resistance to treatment . The purpose of this study was to evaluate the effectiveness of a meditation-based stress reduction program on fibromyalgia . Seventy-seven patients meeting the 1990 criteria of the American College of Rheumatology for fibromyalgia took part in a 10-week group outpatient program . Therapists followed a carefully defined treatment approach and met weekly to further promote uniformity . Patients were evaluated before and after the program . Initial evaluation included a psychiatric structured clinical interview ( SCID ) . Outcome measures included visual analog scales to measure global well-being , pain , sleep , fatigue , and feeling refreshed in the morning . Patients also completed a medical symptom checklist , SCL-90-R , Coping Strategies Question naire , Fibromyalgia Impact Question naire , and the Fibromyalgia Attitude Index . Although the mean scores of all the patients completing the program showed improvement , 51 % showed moderate to marked improvement and only they were counted as " responders . " These preliminary findings suggest that a meditation-based stress reduction program  is effective for patients with fibromyalgia BACKGROUND Chronic fatigue syndrome ( CFS ) , fibromyalgia ( FM ) , and multiple chemical sensitivities ( MCS ) are conditions associated with fatigue and a variety of other symptoms that appear to share many clinical and demographic features . Our objectives were to describe the similarities and differences among patients with CFS , FM , and MCS . Additional objectives were to determine how frequently patients with MCS and FM met the criteria for CFS and if they differed in their health locus of control . METHODS  Demographic , clinical , and psychosocial measures were prospect ively collected in 90 patients , 30 each with CFS , FM , and MCS . Patients were recruited from a university-based referral clinic devoted to the evaluation and treatment of chronic fatigue and three private practice s. Variables included demographic features , symptoms characteristic of each condition , psychological complaints , a measure of health locus of control , and information on health care use .  RESULTS Overall , the three patient groups were remarkably similar in demographic characteristics and the presence of specific symptoms . Patients with CFS and FM frequently reported symptoms compatible with MCS .  Likewise , 70 % of patients with FM and 30 % of those with MCS met the criteria for CFS . Health care use was substantial among patients with CFS , FM , and MCS , with an average of 22.1 , 39.7 , and 23.3 visits , respectively , to a medical provider during the prior year . Health locus of control did not differ among the three population s. CONCLUSIONS In general , demographic and clinical factors and health locus of control do not clearly distinguish patients with CFS , FM , and MCS . Symptoms typical of each disorder are prevalent in the other two conditions Fatigue , which may occasionally be the chief manifestation , is present in more than 90 % of patients with fibromyalgia . It is a significant cause of morbidity and is quite disabling in its ability to disrupt quality of life . The cause of fatigue is complex , but disturbances in sleep architecture may have a role to play . Modafinil , a nonamphetamine wake-promoting agent and a popular treatment of narcolepsy , displays its antifatigue properties through a potentially central prohistaminergic interplay and may conceptually be postulated to lower fatigue in fibromylagia patients as well . Modafinil , unlike amphetamines , is well tolerated with less peripheral hemodynamic alterations combined with low abuse and tolerance sequelae . It also improves vigilance in sleep-deprived patients . Modafinil has been suggested as a possible treatment of fatigue in multiple sclerosis , parkinsonism , depression , primary biliary cirrhosis among other disorders with some demonstrable benefit . Since fatigue constitutes a significant proportion of the morbidity associated with fibromyalgia , we have conducted a retrospective chart review of 98 patients who have fibromyalgia , were being treated by a rheumatologist and 2 nurse practitioners in a private practice setting , and had been given a prescription for modafinil .  Patients were involved in this usual practice setting , and the clinicians documented patient encounters in a st and ard medical record format . The charts were review ed by 5 outside psychiatric clinicians from SUNY Upstate Medical University ’s Depression and Anxiety Disorders Research Program . The study team attempted to exclude charts where there may have been other medical comorbidities that may have induced fatigue and also excluded charts where the initiation of modafinil coincided with the initiation of any other off-label fibromyalgia treatment ( i.e. , duloxetine , amytriptyline , tramadol , etc ) . An analog rating scale was created for this chart review as notes had to be read by study clinicians and retrospective assessment s were made regarding any change in fatigue . This simple scale used a method of visual quantitation of subjective symptomatology change with regard to fatigue . This ranged from a level of 1 , indicative of low fatigue , to 10 , as a representative of the diametrically opposite extreme of marked symptom fatigue . The 5 clinician raters were calibrated to 0.8 accuracy to decrease inter-rater reliability bias . Progress notes were also scanned for reported side effects and for reasons why modafinil may have been discontinued . The average age of the patients was 47 years , and the average dose of modafinil was 162 mg/d , with an average duration of treatment spanning 2 years . The average number of concomitant medications was eight . The mean pre and postfatigue analog scale scores were analyzed and significant statistical difference was demonstrated whereby modafinil augmentation lowered patient fatigue levels from 7.2 0.13 ( severe fatigue ) to 4.4 0.18 ( low-moderate fatigue ( P 0.001 ) . The net mean improvement in fatigue as a target symptom was approximately 28 % . There is often little focus on the fatigue that is commonly reported by these patients . Our simple , retrospective study may be the first that focuses on the use of modafinil for alleviating this symptom . In our retrospective chart review , we found a majority of patients to be involved in both polypharmacy regimens and nonpharmacologic treatment ( i.e. , biofeedback ) as well . The timing of modafinil addition and fatigue amelioration suggests that this agent may be able to effectively treat the fatigue associated with fibromyalgia . It is also a well-tolerated drug with a minimum of side effects reported . These observations should encourage the development of prospect i ve controlled studies Objective . To investigate the relationship between changes in clinical rating scale items and endpoint Patient Global Impression of Improvement ( PGI-I ) . Methods . Data were pooled from 4 r and omized , double-blind , placebo-controlled studies of duloxetine in patients with fibromyalgia ( FM ) . Variables included in the analyses were those that assessed symptoms in FM domains of pain , fatigue , sleep , cognitive difficulties , emotional well-being , physical function , and impact on daily living . The association of endpoint PGI-I with changes from baseline in individual variables was assessed using Pearson product-moment correlations ( r ) . Stepwise linear regression was used to identify those variables for which changes from baseline were statistically significant independent predictors of the endpoint PGI-I ratings . Results . Changes in pain variables and interference of symptoms with the ability to work were highly correlated ( r ≥ 0.5 or r ≤ −0.5 ) with endpoint PGI-I. Moderate correlation with endpoint PGI-I ( 0.30 ≤ r < 0.5 or −0.5 < r ≤ −0.30 ) included changes in variables that assessed physical functioning , depression , anxiety , fatigue , and several variables related to impact on daily living . Independent predictor variables of endpoint PGI-I identified by stepwise linear regression included assessment s for pain , physical function , vitality , anxiety , social function , and tender point thresholds . Conclusion . In addition to pain reduction , what makes patients with FM feel better may include improvement in fatigue , physical functioning , mood , and impact on daily living . An assessment of these domains may be important in clinical trials of FM and in the management of patients with FM In advanced cancer , when cure is impossible , symptoms should be the focus of attention . We report the first prospect i ve , systematic analysis of the severity of 37 symptoms  in 1000 patients with advanced cancer , using the Paradox relational data base . Pain , easy fatigue , and anorexia were consistently among the 10 most prevalent symptoms associated with cancer at all sites . When pain , anorexia , weakness , anxiety , lack of energy , easy fatigue , early satiety , constipation , and dyspnea were present , 60%-80 % of patients rated them as moderate or severe , i.e. of clinical importance . The most common symptoms were also the most severe . In general the same symptoms were clinical ly important at most primary sites . Clinical ly important dyspnea , hoarseness , hiccough , and dysphagia were more common in men ; anxiety , nausea , vomiting , and early satiety in women . Clinical ly important dyspepsia , nausea , and vomiting occurred more frequently in gynecological cancers The purpose of this study was to compare the effects of aerobic training with a muscle-strengthening program in patients with fibromyalgia . Thirty women with fibromyalgia were r and omized to either an aerobic exercise ( AE ) program or a strengthening exercise ( SE ) program for 8 weeks . Outcome measures included the intensity of fibromyalgia-related symptoms , tender point count , fitness ( 6-min walk distance ) , hospital anxiety and depression ( HAD ) scale , and short-form health survey ( SF-36 ) . There were significant improvements in both groups regarding pain , sleep , fatigue , tender point count , and fitness after treatment . HAD-depression scores improved significantly in both groups while no significant change occurred in HAD-anxiety scores . Bodily pain subscale of SF-36 and physical component summary improved significantly in the AE group , whereas seven subscales of SF-36 , physical component summary , and mental component summary improved significantly in the SE group . When the groups were compared after treatment , there were no significant differences in pain , sleep , fatigue , tender point count , fitness , HAD scores , and SF-36 scores . AE and SE are similarly effective at improving symptoms , tender point count , fitness , depression , and quality of life in fibromyalgia OBJECTIVE Cancer-related fatigue ( CRF ) is one of the most common , persistent , and disabling symptoms associated with cancer and its treatment . Evidence -based treatments that are acceptable to patients are critically needed . This study examined the efficacy of mindfulness-based stress reduction ( MBSR ) for CRF and related symptoms . METHOD A sample of 35 cancer survivors with clinical ly significant CRF was r and omly assigned to a 7-week MBSR-based intervention or wait-list control group . The intervention group received training in mindfulness meditation , yoga , and self-regulatory responses to stress .  Fatigue interference ( primary outcome ) and a variety of secondary outcomes ( e.g. , fatigue severity , vitality , disability , depression , anxiety , and sleep disturbance ) were assessed at baseline , post-intervention , and 1-month follow-up . Bonferroni correction was employed to account for multiple comparisons . Controls received the intervention after the 1-month follow-up . Participants in both groups were followed for 6 months after completing their respective MBSR courses to assess maintenance of effects . RESULTS Compared to controls , the MBSR group reported large post-intervention reductions as assessed by effect sizes ( d ) in the primary outcome , fatigue interference ( d = -1.43 , p < 0.001 ) , along with fatigue severity ( d = -1.55 , p < 0.001 ) , vitality ( d = 1.29 , p < 0.001 ) , depression ( d = -1.30 , p < 0.001 ) , and sleep disturbance ( d = -0.74 , p = 0.001 ) . Results were maintained or strengthened at 1-month follow-up , the point at which significant improvements in disability ( d = -1.22 , p < 0.002 ) and anxiety ( d = -0.98 , p = 0.002 ) occurred . Improvements in all outcomes were maintained 6 months after completing the course . MBSR adherence was high , with 90 % attendance across groups and high rates of participant-reported home practice of mindfulness . CONCLUSIONS Mindfulness-based stress reduction is a promising treatment for CRF and associated symptoms Abstract Purpose Women with breast cancer may experience symptoms of depression , anxiety , pain , fatigue and sleep disturbances during chemotherapy .  However , there are few modalities that address multiple , commonly occurring symptoms that may occur in individuals receiving cancer treatment .  Cranial electrical stimulation ( CES ) is a treatment that is FDA cleared for depression , anxiety and insomnia . CES is applied via electrodes placed on the ear that deliver pulsed , low amplitude electrical current to the head . Methods This phase III r and omized , sham-controlled study aim ed to examine the effects of cranial microcurrent stimulation on symptoms of depression , anxiety , pain , fatigue , and sleep disturbances in women receiving chemotherapy for early-stage breast cancer . Patients were r and omly assigned to either an actual or sham device and used the device daily for 1 h. The study was registered at clinical trials.gov , NCT00902330 . Results The sample included N = 167 women with early-stage breast cancer .  Symptom severity of depression , anxiety , and fatigue and sleep disturbances were generally mild to moderate . Levels of pain were low . Anxiety was highest prior to the initial chemotherapy and decreased over time . The primary outcome assessment ( symptoms of depression , anxiety , fatigue , pain , sleep disturbances ) revealed no statistically significant differences between the two groups , actual CES vs. sham . Conclusion In this study , women receiving chemotherapy for breast cancer experienced multiple symptoms in the mild to moderate range . Although there is no evidence for the routine use of CES during the chemotherapy period for symptom management in women with breast cancer , further symptom management modalities should be evaluated to mitigate symptoms of depression , anxiety , fatigue , pain and sleep disturbances over the course of chemotherapy CONTEXT Breast cancer survivors ( BCS ) face adverse physical and psychological symptoms , often co-occurring . Biologic and psychological factors may link symptoms within clusters , distinguishable by prevalence and /or severity . Few studies have examined the effects of behavioral interventions or treatment of symptom clusters . OBJECTIVES The aim of this study was to identify symptom clusters among post-treatment BCS and determine symptom cluster improvement following the Mindfulness-Based Stress Reduction for Breast Cancer ( MBSR(BC ) ) program . METHODS Three hundred twenty-two Stage 0-III post-treatment BCS were r and omly assigned to either a six-week MBSR(BC ) program or usual care .  Psychological ( depression , anxiety , stress , and fear of recurrence ) , physical ( fatigue , pain , sleep , and drowsiness ) , and cognitive symptoms and quality of life were assessed at baseline , six , and 12 weeks , along with demographic and clinical history data at baseline . A three-step analytic process included the error-accounting models of factor analysis and structural equation modeling . RESULTS Four symptom clusters emerged at baseline : pain , psychological , fatigue , and cognitive . From baseline to six weeks , the model demonstrated evidence of MBSR(BC ) effectiveness in both the psychological ( anxiety , depression , perceived stress and QOL , emotional well-being ) ( P = 0.007 ) and fatigue ( fatigue , sleep , and drowsiness ) ( P < 0.001 ) clusters . Results between six and 12 weeks showed sustained effects , but further improvement was not observed . CONCLUSION Our results provide clinical effectiveness evidence that MBSR(BC ) works to improve symptom clusters , particularly for psychological and fatigue symptom clusters , with the greatest improvement occurring during the six-week program with sustained effects for several weeks after MBSR(BC ) training . TRIAL REGISTRATION Name and URL of Registry : Clinical Trials.gov . Registration number : NCT01177124 Background Chronic fatigue syndrome ( CFS ) presents a challenge for patients , health care providers , and health insurance groups because of its incapacitating nature , unknown cause , and poorly understood prognosis . We conducted a longitudinal population -based study to characterize the clinical course of CFS . Methods Sixty-five CFS subjects were identified from a r and om-digit-dialing survey of Wichita , Kansas residents and followed for up to 3 years . We evaluated changes in CFS classification ( partial or total remission , alternative medical or psychiatric diagnoses ) , CFS case-defining criteria , wellness scores , hours of activities and sleep , and  treatments used to reduce fatigue . Associations between risk factors and outcomes were determined by use of logistic regression and generalized estimating equations models . Results Only 20%-33 % of the subjects were classified as having CFS at follow-up , 56.9 % ever experienced partial or total remission , 10 % sustained total remission , and 23.1 % received alternative diagnoses , of which 20 % were sleep disorders . Higher fatigue severity scores and total number of symptoms were negatively associated with ever remitting . Duration of illness ≤ 2 years was positively associated with sustained remission . Unrefreshing sleep persisted in at least 79 % of the subjects across all periods but , as with most of the CFS symptoms , tended to be less frequent over time . The number of activities affected by fatigue decreased over time , while wellness scores increased . At any follow-up , more than 35 % of subjects reporting reduced fatigue used complementary and alternative medicine therapies , and of those subjects , at least 50 % thought these therapies were responsible for reducing their fatigue . Conclusions The clinical course of CFS was characterized by an intermittent pattern of relapse and remission . Remission rates documented by our population -based study were similar to those reported in clinical studies . Shorter illness duration was a significant predictor of sustained remission , and thus early detection of CFS is of utmost importance . The persistence of sleep complaints and identification of sleep disorders suggest that CFS subjects be evaluated for sleep disturbances , which could be treated BACKGROUND Depression , anxiety , fatigue and sleep disorders occur commonly in patients with Parkinson 's disease ( PD ) . These non-motor symptoms often contribute to the reduction of functional abilities in PD patients . OBJECTIVE This study was design ed to evaluate the diagnostic accuracy of the treating neurologist for a variety of behavioral symptoms commonly associated with PD . METHODS A prospect i ve evaluation of 101 patients with PD selected in no particular order was conducted . All patients were evaluated with the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Hoehn & Yahr Stage ( H/Y ) , and the Schwab & Engl and Scale ( S/E ) . The patients completed a brief screening question naire for depression and anxiety followed by the administration of a battery of st and ardized tests including the Beck Depression Inventory ( BDI ) , Beck Anxiety Inventory ( BAI ) , Fatigue Severity Scale ( FSS ) , and the Pittsburgh Sleep Quality Inventory ( PSQI ) .  RESULTS St and ardized testing showed evidence of a problem with depression in 44 % of patients , anxiety in 39 % , fatigue in 42 % and sleep disturbance in 43 % . The prevalence of these conditions , identified by the treating neurologist was lower : 21 % with depression , 19 % with anxiety , 14 % with fatigue and 39 % with sleep disturbance . The diagnostic accuracy for the treating neurologists was 35 % for depression , 42 % for anxiety , 25 % for fatigue , and 60 % for sleep disturbance . CONCLUSION This study demonstrates that during routine office visits , neurologists failed to identify the presence of depression , anxiety , and fatigue more than half of the time and failed to recognize sleep disturbance in 40 % of patients . Awareness of the likelihood of underrecognition of behavioral symptoms in PD should generate approaches to improve diagnostic accuracy and facilitate timely therapeutic interventions Fibromyalgia is a chronic condition characterized by widespread pain , fatigue , non-restorative sleep and cognitive difficulties that affects 2 - 4 % of the general population . Recently a possible relationship between the FMR1 premutation and fibromyalgia has been pointed out . In attempt to gather more data we screened for the  FMR1 CGG expansion 700 DNA sample s from unrelated fibromyalgia patients . This data might be useful for evaluating the incorporation of this test in rheumatologic procedures for women with fibromyalgia . The observed frequency of  FMR1 premutation carriers ( 3 of 700 , 0.4 % ) is not significantly different from the estimated rate in the general female population ( 1/250 - 1/400 ) ( P=0.539 , P=0.716 ) . Clinical examination of the FMR1 premutation carriers identified revealed that all of them had important neurological symptoms with regard to muscular symptoms , neurocognitive alterations and neurovegetative impairments . With regard to other clinical aspects of the disease the cases apparently did not differ from the average fibromyalgia patients . On the basis of our results an FMR1 screening among fibromyalgia female patients would not be recommended . However it would be worthwhile to further evaluate the different clinical presentations that fibromyalgia patients might present based on their FMR1 premutation carrier status OBJECTIVE To prospect ively evaluate for changes in objective cognitive performance ( attention , memory , and executive function ) and psychiatric symptom severity ( depression , anxiety , fatigue , and pain ) in patients before , during and after interferon-alpha based therapy ( IFN ) for chronic hepatitis C virus infection ( HCV ) . METHODS 33 HCV+ adults were evaluated two months before  IFN initiation ( baseline ) , three months into IFN , and six months following IFN termination ( IFN+ Group ) . 31 HCV+ adults who did not undergo IFN therapy were evaluated at baseline and six months later ( IFN- Group ) . At each evaluation , participants completed the  Neuropsychological Assessment Battery ( NAB ) Attention , Memory and Executive Functions Modules , the Beck Depression Inventory , Second Edition ( BDI ) , Generalized Anxiety Disorder Inventory ( GADI ) , Fatigue Severity Scale ( FSS ) , and Brief Pain Inventory ( BPI ) . RESULTS Compared with the IFN- Group , the IFN+ Group experienced significantly ( p<0.050 ) increased symptoms of depression , anxiety , fatigue and pain during IFN therapy relative to baseline . In the IFN+ Group , psychiatric symptoms generally returned to baseline levels following IFN termination . Sustained viral response was associated with significantly lower depression and fatigue . No significant changes in cognitive performance were observed . CONCLUSIONS During IFN , patients with HCV evidence significantly increased psychiatric symptoms , including symptoms of depression , anxiety , fatigue and pain . These psychiatric symptoms are generally short-term and remit following IFN termination , with increased benefit if viral clearance is achieved . However , IFN is not associated with significant declines in objective cognitive performance during or following IFN OBJECTIVE Fibromyalgia syndrome ( FMS ) is characterized by widespread musculoskeletal pain and lowered pain threshold . Other prominent symptoms include disordered sleep and fatigue . FMS affects an estimated 2 % of the population , predominantly women . This trial was design ed to evaluate the efficacy and safety of pregabalin , a novel alpha(2)-delta lig and , for treatment of symptoms associated with FMS . METHODS This multicenter , double-blind , 8-week , r and omized clinical trial compared the effects of placebo with those of 150 , 300 , and 450 mg/day pregabalin on pain , sleep , fatigue , and health-related quality of life in 529 patients with FMS . The primary outcome variable was the comparison of end point mean pain scores , derived from daily diary ratings of pain intensity , between each of the pregabalin treatment groups and the placebo group . RESULTS Pregabalin at 450 mg/day significantly reduced the average severity of pain in the primary analysis compared with placebo ( -0.93 on a 0 - 10 scale ) ( P < /= 0.001 ) , and significantly more patients in this group had > /=50 % improvement in pain at the end point ( 29 % , versus 13 % in the placebo group ; P = 0.003 ) . Pregabalin at 300 and 450 mg/day was associated with significant improvements in sleep quality , fatigue , and global measures of change .  Pregabalin at 450 mg/day improved several domains of health-related quality of life . Dizziness and somnolence were the most frequent adverse events . Rates of discontinuation due to adverse events were similar across all 4 treatment groups . CONCLUSION Pregabalin at 450 mg/day was efficacious for the treatment of FMS , reducing symptoms of pain , disturbed sleep , and fatigue compared with placebo . Pregabalin was well tolerated and improved global measures and health-related quality of life While fatigue is found to be an impairing symptom in functional motor disorders ( FMD ) in clinical practice , scientific evidence is lacking . We investigated fatigue severity and subtypes in FMD compared to organic neurological disease . Furthermore , the role of fatigue within FMD and its impact on quality of life and self-rated health were investigated . Data from 181 patients participating in the self-help on the internet for functional motor disorders , r and omised Trial were included . Data from 217 neurological controls with neuromuscular disorders ( NMD ) originated from a historical cohort .  Fatigue was measured using the checklist individual strength ( CIS ) . Motor symptom severity , depression and anxiety were correlated to fatigue . For multivariable regression analyses , physical functioning and pain were additionally taken into account . Severe fatigue was , respectively , present in 78 and 53 % of FMD and NMD patients ( p < 0.001 ) . FMD patients scored higher than NMD patients on all fatigue subdomains ( p < 0.001 ) . In the FMD group , fatigue subdomains were correlated to depression , anxiety and partly to motor symptom severity . Quality of life was negatively associated with fatigue [ OR 0.93 ( 0.90–0.96 ) , p < 0.001 ] and depression [ OR 0.87 ( 0.81–0.93 ) , p < 0.001 ] , but not self-rated motor symptom severity . Self-rated health was negatively associated with fatigue [ OR 0.92 ( 0.88–0.96 ) , p < 0.001 ] and pain [ OR 0.98 ( 0.97–0.99 ) , p < 0.001 ] . Fatigue was found to be a prevalent problem in FMD , more so than in organic neurological disease . It significantly affected quality of life and self-rated health , while other factors such as motor symptom severity did not . Fatigue should be taken into account in clinical practice and treatment trials Research on comorbidity across cancer symptoms , including pain , fatigue , and depression , could suggest if crossover effects from symptom-specific interventions are plausible . Secondary analyses were conducted on a survey of 268 cancer patients with recurrent disease from a northeastern U.S. city who were initiating palliative radiation for bone pain .  Moderator regression analyses predicted variation in depressive affect that could be attributed to symptom clusters . Patients self-reported difficulty controlling each physical symptom over the past month on a Likert scale and depressive symptoms on a vali date d depression measure ( Center for Epidemiologic Studies -Depression [ CES-D ] ) over the past week on a four-category scale . An index of depressive affect was based on items of negative and positive affect from the CES-D. In predicting depressive affect , synergistic interactions of pain with fever , fatigue , and weight loss suggest separate pathways involving pain . A similar interaction with fever occurs when nausea was tested in place of pain . Further , the interaction between pain and fatigue is similar in form to the interaction between difficulty breathing and fatigue ( when sleep is not a problem ) . Follow-up to the latter interaction reveals : 1 ) additional moderation by hypertension and palliative radiation to the hip/pelvis ; and 2 ) a similar cluster not involving hypertension when appetite problems and weight loss were tested in place of fatigue . The significance and form of these interactions are remarkably consistent . Similar sickness mechanisms could be generating : 1 ) pain and nausea during fever ; 2 ) pain and fatigue during weight loss ; and 3 ) pain and breathing difficulty when fatigue is pronounced . Crossover effects from symptom-specific interventions appear promising Background Several recent review s have evaluated evidence on the efficacy of Mindfulness-Based Stress Reduction ( MBSR ) among fibromyalgia sufferers , and concluded that more research should test effects on both psychological and physiological functioning . Purpose We conducted a r and omized prospect i ve trial of MBSR among female fibromyalgia patients . Methods Effects on perceived stress , pain , sleep quality , fatigue , symptom severity , and salivary cortisol were tested in  treatment ( n = 51 ) versus wait-list control participants ( n = 40 ) using data at baseline , post-program , and 2-month follow-up . Results Analyses revealed that MBSR significantly reduced perceived stress , sleep disturbance , and symptom severity , with gains maintained at follow-up . Greater home practice at follow-up was associated with reduced symptom severity .  MBSR did not significantly alter pain , physical functioning , or cortisol profiles . Conclusion MBSR ameliorated some of the major symptoms of fibromyalgia and reduced subjective illness burden . Further exploration of MBSR effects on physiological stress responses is warranted . These results support use of MBSR as a complementary treatment for women with fibromyalgia ( IS RCT N : 34628811 ) BACKGROUND Chronic fatigue syndrome ( CFS ) is a condition that may be associated with substantial disability . The Medical Outcomes Study Short-Form General Health Survey ( SF-36 ) is an instrument that has been widely used in outpatient population s to determine functional status . Our objectives were to describe the usefulness of the SF-36 in CFS patients and to determine if subscale scores could distinguish patients with CFS from subjects with unexplained chronic fatigue ( CF ) , major depression ( MD ) , or acute infectious mononucleosis ( AIM ) , and from healthy control subjects ( HC ) . An additional goal was to ascertain if subscale scores correlated with the signs and symptoms of CFS or the presence of psychiatric disorders and fibromyalgia . DESIGN Prospect ively collected case series . SETTING Patients with CFS and CF were seen in a university-based referral clinic and had undergone a complete medical and psychiatric evaluation . Other study subjects were recruited from the community to participate in research studies . PARTICIPANTS The study included 185 patients with CFS , 246 with CF , 111 with AIM , and 25 with MD . There were 99 HC subjects . MEASURES The  SF-36 and a structured psychiatric interview  were used . The SF-36 contains 8 subscales : physical , emotional , social , and role functioning , body pain , mental health , vitality , and general health- and a structured psychiatric interview .  RESULTS Performance characteristics ( internal reliability coefficients , convergent validity ) of the SF-36 were excellent . A strikingly consistent pattern was found for the physical functioning , role functioning , social functioning , general health , and body pain subscales , with the lowest scores in CFS patients , intermediate scores in AIM patients , and the highest scores in the HC subjects . The CFS patients had significantly lower scores than patients with CF alone on the physical functioning ( P < or = 0.01 ) , role functioning ( P < or = 0.01 ) , and body pain ( P < or = 0.001 ) subscales . The emotional functioning and mental health scores were worst among those with MD . The presence of fibromyalgia , being unemployed , and increasing fatigue severity all were associated with additional functional limitations across multiple functional domains , with increasing fatigue appearing to have the greatest effect . CONCLUSIONS The SF-36 is useful in assessing functional status in patients with fatiguing illnesses . Patients with CFS and CF have marked impairment of their functional status . The severity and pattern of impairment as documented by the SF-36 distinguishes patients with CFS and CF from those with MD and AIM , and from HC , but does not discriminate between CF and CFS CONTEXT A novel mind-body approach ( amygdala retraining ) is hypothesized to improve symptoms related to  fibromyalgia and chronic fatigue .  OBJECTIVE To examine the use of a mind-body approach for improving symptoms related to  fibromyalgia and chronic fatigue .  DESIGN This was a single-blind , r and omized controlled trial . SETTING The study was conducted in a tertiary-care fibromyalgia and chronic fatigue clinic . PATIENTS Patients with fibromyalgia , chronic fatigue , or both were included . INTERVENTIONS Patients were r and omly assigned to receive amygdala retraining along with st and ard care or st and ard care alone . St and ard care involved attending a 1.5-day multidisciplinary program . The amygdala retraining group received an additional 2.5-hour training course in which the key tools and techniques adapted from an existing program were taught to the patient . A home- study video course and associated text were provided to supplement the on-site program . Both groups received telephone calls twice a month to answer questions related to technique and to provide support . MAIN OUTCOME MEASURES Vali date d self-report question naires related to general health , well-being , and symptoms , including Short Form-36 , Measure Yourself Medical Outcome Profile , Multidimensional Fatigue Inventory , Epworth Sleepiness Scale , and Fibromyalgia Impact Question naire . RESULTS Of the 44 patients r and omly assigned who completed baseline assessment s , 21 patients completed the study ( 14 in the st and ard care group and 7 in the study group ) . Median age was 48 years ( range , 27 - 56 years ) , and female subjects comprised 91 % of the group . Analyses demonstrated statistically significant improvements in scores for physical health , energy , pain , symptom distress , and fatigue in patients who received the amygdala retraining compared with st and ard care
While no clinical trial to date has specifically targeted fatigue , r and omized controlled trials , systematic review s , and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue .
Fatigue is a disabling , multifaceted symptom that is highly prevalent and stubbornly persistent .
Although fatigue is a frequent complaint among patients with fibromyalgia , it has not received the same attention as pain .
Reasons for this include lack of st and ardized nomenclature to communicate about fatigue , lack of evidence -based guidelines for fatigue assessment , and a deficiency in effective treatment strategies .
Fatigue does not occur in isolation ; rather , it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain , unrefreshing sleep , anxiety , depression , cognitive difficulties , and so on .
Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms .