Research highlights:

  • 14.6% of adolescents with CFS also experienced chronic widespread pain
  • Females twice as likely to have CFS or CWP
  • Exclusive CFS (vs non-CFS) was associated with higher levels of reported pain and greater effect of pain
  • This association attenuated after adjustment for covariates (e.g. depression, anxiety, obesity)
  • Higher levels of depressive & anxiety symptoms are associated with higher odds of comorbid CFS & CWP

Research abstract:

Whilst many studies have investigated the overlap between pain phenotypes and chronic fatigue syndrome (CFS) in adults, little is known about the relationship between these conditions in adolescents.

The study’s aim was therefore to identify whether a relationship exists between chronic widespread pain (CWP) and CFS in adolescents and investigate whether the two share common associations with a set of covariates.

A questionnaire was administered to offspring of the Avon Longitudinal Study of Parents and Children at age 17, asking about site, duration, and pain intensity, from which participants with CWP were identified. 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 relationship between selected covariates and CFS and CWP was investigated using a variety of logistic, ordinal logistic and multinomial regressions. 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 only related to anxiety.

In this cohort, 14.6% of adolescents with CFS have co-morbid CWP. The likely greater proportion of more mild cases observed in this epidemiological study means that prevalence of overlap may be underestimated compared to those attending specialist services. Clinicians should be aware of the overlap between the two conditions and carefully consider treatment options offered.

Chronic Fatigue Syndrome and chronic widespread pain in adolescence: Population birth cohort study, by Tom Norris, Kevin Deere, Jon H. Tobias, Esther Crawley in The Journal of Pain [Preprint Available online 12 November 2016]

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