Coping strategies in patients with good outcome but chronic fatigue after aneurysmal subarachnoid hemorrhage 2023 Ghafaji et al

Background
Fatigue is a highly prevalent and debilitating symptom among patients in the chronic phase of aneurysmal subarachnoid haemorrhage (aSAH) with no identified effective treatment. Cognitive therapy has been shown to have moderate effects on fatigue. Delineating the coping strategies used by patients with post-aSAH fatigue and relating them to fatigue severity and emotional symptoms could be a step towards developing a behavioural therapy for post-aSAH fatigue.

Methods
Ninety-six good outcome patients with chronic post-aSAH fatigue answered the questionnaires Brief COPE, (a questionnaire defining 14 coping strategies and three Coping Styles), the Fatigue Severity Scale (FSS), Mental Fatigue Scale (MFS), Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). The Brief COPE scores were compared with fatigue severity and emotional symptoms of the patients.

Results
The prevailing coping strategies were “Acceptance”, “Emotional Support”, “Active Coping” and “Planning”. “Acceptance” was the sole coping strategy that was significantly inversely related to levels of fatigue. Patients with the highest scores for mental fatigue and those with clinically significant emotional symptoms applied significantly more maladaptive avoidant strategies. Females and the youngest patients applied more “Problem-Focused” strategies.

Conclusion
A therapeutic behavioural model aiming at furthering “Acceptance” and reducing passivity and “Avoidant” strategies may contribute to alleviate post-aSAH fatigue in good outcome patients. Given the chronic nature of post-aSAH fatigue, neurosurgeons may encourage patients to accept their new situation so that they can start a process of positive reframing instead of being trapped in a spiral of futile loss of energy and secondary increased emotional burden and frustration.

Open access, https://link.springer.com/article/10.1007/s00701-023-05549-y

 

"Thastum et al. developed a treatment strategy in chronic post-concussion syndrome applying the idea of negative illness perception and maladaptive illness behaviour intended to break the vicious circles of excessive rest due to fatigue by gradually changing attitudes and slowly increasing participation in daily activities [43]. Likewise, cognitive behavioural therapy, graded exercise therapy, and acceptance and commitment therapy has been employed to treat mental fatigue syndrome and fatigue in chronic pain syndromes [7, 8, 21, 38]. Hence, in order to develop similar behavioural therapy approaches customized for post-aSAH fatigue, knowledge of applied coping strategies in that group of patients would be crucial. However, no study has yet assessed coping using the Brief-COPE in aSAH patients, nor has the relationship between coping strategies and post-aSAH fatigue been elucidated. We therefore aim at delineating coping strategies in good outcome patients with post-aSAH fatigue and relate coping to fatigue intensity and emotional symptoms."

 

Sounds a lot like the patients are lowering their expectations of what is normal and simply endure it. When you are used to 9/10 energy and now live with 2/10, even 4/10 is pretty damn sweet. Especially once you clearly notice that MDs don't have a clue about this and there's no point communicating any of that to them.

Then of course when you have BS like the CFQ, have been stuck at 2/10, a 3/10 is less fatigue than last time even though it's a disabling level. As long as you don't measure anything, you can basically not care about what's real or not.

What a complete waste of resources and patients' lives.