Chronic fatigue complaints in primary care: Incidence and diagnostic patterns

Abstract

The complaint of chronic fatigue is ubiquitous in the primary care setting. Because of the nonspecific nature of chronic fatigue, practitioners do not focus on this complaint. Furthermore, most physicians use a problem-based approach. Such a prematurely narrowed focus could overlook the chronic fatigue complaint. Omissions in the data collection process would prove this oversight. Therefore, we postulated that a retrospective review of evaluations for chronic fatigue would demonstrate significant categorical deficiencies. These deficiencies would indicate a problem focus different than the chronic fatigue complaint itself. The authors reviewed the current literature to establish historical, physical, and laboratory findings pertinent to the evaluation of chronic fatigue. Six major categories and the associated data elements were identified for use in analyzing patient records. The patient records from the preceding 6 months were reviewed to find those containing a complaint of chronic fatigue. These records were analyzed to determine if a complete data set had been sought and if an associated diagnosis was made. A total of 425 consecutive charts from an academic family practice clinic were retrospectively reviewed; 9.9% (42) mentioned chronic fatigue. Physicians were lax in performing the mental status and physical examinations; taking the patient's psychiatric and sleep history, as well as the history of chief complaint; and ordering laboratory evaluations. The physician diagnoses included: depression (40.4%), nonspecific fatigue (35.7%), general medical disorders (16.6%), chronic fatigue syndrome (2.4%), fibromyalgia (2.4%), and sleep apnea (2.4%). From these data, the investigators conclude that the workup for chronic fatigue is often incomplete or lacks documentation. This oversight is likely due to a problem focus not directed at the chronic fatigue complaint. Also complicating the evaluation process are the multiple associated disorders, the prevalence of the complaint, and costibenefit issues facing the primary care physician.

The Prevalence, Cost Implications, and Management of Sleep Disorders: An Overview

“…14,17,19 Fatigue can be defined as an overwhelming sense of tiredness, lack of energy and a feeling of exhaustion, and im-paired physical and cognitive functioning, which needs to be distinguished from symptoms of depression, which include lack of self-esteem, sadness, and despair or hopelessness. [20][21][22][23] Occasional fatigue can be a part of the strain of everyday life; however, constant or frequent fatigue is suspected to be related to conditions of physical or psychological illness. 24 An epidemiological study measuring fatigue in a random sample of the general population reported no firm associations between fatigue and social variables, but fatigue seems to be highly prevalent in somatic and psychiatric disorders.…”

“…Either or both may be caused by various sleep-related disorders such as sleep apnea, periodic limb movement disorder (PLMD), narcolepsy, drug and alcohol abuse, psychiatric disorders, circadian rhythm disorders, medical disorders, and iatrogenic factors. [13][14][15]19,20 These common manifestations of sleep problems may have separate economic consequences because of different treatment requirements and distinct comorbidity profiles. Sleep restriction (the Toronto syndrome) is probably the most common cause of excessive sleepiness in North America and occurs as a result of inadequate sleep hygiene, in which individuals adapt their lifestyle to work and other commitments and compromise sleep time.…”

Underlying sleep pathology may cause chronic high fatigue in shift‐workers

“…Either or both may be caused by a broad range of sleep disorders, such as sleep apnea, periodic limb movement disorder, narcolepsy, psychophysiologic insomnia, circadian rhythm sleep disorders, chronic fatigue syndrome, fibromyalgia, alcohol and drug abuse, and psychiatric disorders (Abbey and Shapiro 1995; Hanly and Shapiro 1995; Lichstein et al. 1997; Ohayon and Shapiro 2000; Ward et al. 1996).…”

Primary Care: Is It the Setting to Address Sleep Disorders?

“…[14][15][16][17][18][19] It is not clear that any of these efforts have met with outstanding success. Such efforts have ranged from holding informal group meetings, to advocating sleep testing for sleep disordered breathing in the home, and even for nocturnal penile tumescence (NPT) measures in the home.…”