Abstract
ObjectiveThe relationship between fatigue and pain has been investigated previously, but little is known about the prevalence of substantial fatigue in patients sick-listed for chronic low back pain (CLBP) and about how fatigue is associated with depression, pain, and long-term disability. The aims of the study were to examine the prevalence of substantial fatigue; associations between fatigue, depression, and pain; and whether fatigue predicted long-term disability.MethodsFive hundred sixty-nine patients participating in a randomized controlled trial and sick-listed 2–10 months for LBP were included in the study. Cross-sectional analyses were conducted to investigate the prevalence and independent associations between fatigue, depression, pain, and disability, while longitudinal analyses were done to investigate the association between fatigue and long-term disability.ResultsThe prevalence of substantial fatigue was 69.7%. Women reported significantly more fatigue than men (t = −3.6, df = 551; P < .001). Those with substantial fatigue had higher pain intensity (t = −3.3, df = 534; P = 0.01), more depressive symptoms (t = −10.9, df = 454; P < 0.001), and more disability (t = −7.6, df = 539; P < 0.001) than those without substantial fatigue. Musculoskeletal pain and depression were independently associated with substantial fatigue. In the longitudinal analyses, fatigue predicted long-term disability at 3, 6, and 12 months' follow-up. After pain and depression were controlled for, fatigue remained a significant predictor of disability at 6 months' follow-up.ConclusionsThe vast majority of the sick-listed CLBP patients reported substantial fatigue. Those with substantial fatigue had more pain and depressive symptoms and a significant risk of reporting more disability at 3, 6, and 12 months. Substantial fatigue is disabling in itself but also involves a risk of developing chronic fatigue syndrome and long-term disability.
Highlights
Chronic low back pain (CLBP) represents a major public health problem in Western societies
Musculoskeletal pain and depression were independently associated with substantial fatigue
Women reported significantly higher scores on fatigue compared with men (t = −3.6, df = 551; P < .001)
Summary
Chronic low back pain (CLBP) represents a major public health problem in Western societies It is the leading cause of long-term sick leave in Norway and is often associated with substantial disability [1,2] and a high degree of comorbidity. The comorbidity involves both mental disorders [3] and other health complaints [4], including tiredness and fatigue [5]. The current study will be covering the mental and physical aspects of fatigue [7], as described and applied in previous studies [8,9] These involve cognitive difficulties, tiredness and sleepiness, reduced strength and endurance, and loss of interest and motivation [10]
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