Skip to main content

Advertisement

SpringerLink
Log in

Variation in fatigue may be poorly explained by pain: results from a longitudinal, exploratory study

  • Short Communication - Observational Research
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

It is frequently claimed that fatigue reflects pain and that strategies for alleviating fatigue in patients with ankylosing spondylitis (AS) should focus on pain management. The aim of this study was twofold: to investigate the correlation between fatigue and pain over time and to investigate the temporal relationship between fatigue and pain in patients with AS. Fatigue and pain were assessed twice a week for 35 weeks in 23 patients with AS. Data were reported with text messages on mobile phones, constituting around 70 repeated measurements per patient. To estimate correlation over time, the correlation coefficient within individuals was estimated. When estimating the temporal relationship, we lagged the independent variable and performed individual linear regression. In 16 (70 %) of the patients, ≤36 % of the variance in fatigue was explained by pain. The association between fatigue and pain was synchronous in time in 13 (57 %) patients, while 5 (22 %) patients reported that fatigue precedes pain by 1 week and 5 (22 %) that pain precedes fatigue by 1 week. Fatigue and pain may be two separate and independent symptoms in some patients with AS. The clinical implication is that the two symptoms should be targeted separately because it cannot always be expected that an improvement in one is followed by an improvement in the other.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Hewlett S, Cockshott Z, Byron M, Kitchen K, Tipler S, Pope D et al (2005) Patients’ perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Arthritis Rheum 53(5):697–702

    Article  PubMed  Google Scholar 

  2. Dagfinrud H, Vollestad NK, Loge JH, Kvien TK, Mengshoel AM (2005) Fatigue in patients with ankylosing spondylitis: a comparison with the general population and associations with clinical and self-reported measures. Arthritis Rheum 53(1):5–11

    Article  PubMed  Google Scholar 

  3. Brophy S, Davies H, Dennis MS, Cooksey R, Husain MJ, Irvine E, Sibert S (2013) Fatigue in ankylosing spondylitis: treatment should focus on pain management. Semin Arthritis Rheum 42(4):361–367

    Article  PubMed  Google Scholar 

  4. Repping-Wuts H, Fransen J, van Achterberg T, Bleijenberg G, van Riel P (2007) Persistent severe fatigue in patients with rheumatoid arthritis. J Clin Nurse 16(11c):377–383

    Article  Google Scholar 

  5. Zochling J, Braun J (2007) Assessments in ankylosing spondylitis. Best Pract Res Clin Rheumatol 21(4):699–712

    Article  PubMed  Google Scholar 

  6. Nikolaus S, Bode C, Taal E, van de Laar MA (2013) Fatigue and factors related to fatigue in rheumatoid arthritis: a systematic review. Arthritis Care Res (Hoboken) 65(7):1128–1146

    Article  Google Scholar 

  7. van Tubergen A, Coenen J, Landewe R, Spoorenberg A, Chorus A, Boonen A, van der Linden S, van der Heijde D (2002) Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis. Arthritis Rheum 47(1):8–16

    Article  PubMed  Google Scholar 

  8. Pollard LC, Choy EH, Gonzalez J, Khoshaba B, Scott DL (2006) Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology (Oxford) 45(7):885–889

    Article  CAS  Google Scholar 

  9. van Dartel SA, Repping-Wuts JW, van Hoogmoed D, Bleijenberg G, van Riel PL, Fransen J (2013) Association between fatigue and pain in rheumatoid arthritis: does pain precede fatigue or does fatigue precede pain? Arthritis Care Res (Hoboken) 65(6):862–869

    Article  Google Scholar 

  10. Heiberg TMP, Kvien TK, Hagen KB (2009) Patterns of symptom variation: Is level of fatigue independent of pain intensity in patients with rheumatoid arthritis (RA)?. Ann Rheum Dis, EULAR, p 149

    Google Scholar 

  11. Christie A, Hagen KB, Mowinckel P, Dagfinrud H (2014) Aquatic exercises were associated with an acceptable state of symptoms in patients with inflammatory rheumatic diseases: results from a study with interrupted time-series design. Musculoskelet Care. Des 10. (Epub ahead of print)

  12. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank the participating patients and physiotherapists at Rehabiliteringssenteret Nord-Norges Kurbad in Tromsø, Revmatismesykehuset in Lillehammer, and Haugesunds Sanitetsforenings Revmatismesykehus for their substantial contribution to the study.

Funding information

This study has received grants from The Norwegian Rheumatism Association’s Research Fund and from the Oslo Health Association.

Author information

Authors and Affiliations

  1. National Advisory Unit for Rehabilitation on Rheumatology (NKRR), Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319, Oslo, Norway

    Anne Christie, Hanne Dagfinrud, Petter Mowinckel & Kåre Birger Hagen

Authors
  1. Anne Christie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hanne Dagfinrud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Petter Mowinckel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kåre Birger Hagen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne Christie.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Disclosure

This manuscript has not been published before or is not under consideration for publication anywhere. The manuscript has been approved by all co-authors as well as the National Advisory Unit for Rehabilitation on Rheumatology where the work has been carried out.

Ethical standards

All participants signed an informed consent form. The study was approved by the Regional Ethics Committee for Medical Research in Norway (2011/1654).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Christie, A., Dagfinrud, H., Mowinckel, P. et al. Variation in fatigue may be poorly explained by pain: results from a longitudinal, exploratory study. Rheumatol Int 36, 279–282 (2016). https://doi.org/10.1007/s00296-015-3357-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-015-3357-3

Keywords

Search

Navigation