Pain and fatigue – a systematic review, 2019, Conrad et al

Andy

Andy

Retired committee member
Introduction: Chronic pain and fatigue are symptoms that often occur together and characterize the symptom picture of various diseases. Nevertheless, integrative explanatory approaches have so far received little attention in medical practice.

Methods: Based on a systematic literature search in the Embase, Medline, PsychInfo, and CENTRAL databases, we searched for high-quality intervention studies for the simultaneous treatment of pain and fatigue.

Results: From 1,496 total hits, 158 studies were included in the evaluation. The most commonly studied clinical pictures of the symptomcomplex were tumor catabolism, fibromyalgia, chronic fatigue, rheumatoid arthritis, and osteoarthritis.Current explanations of the symptom complex focus on the activation of proinflammatory microglia in centralized pain syndrome with multiple effects on neurotransmission, neuroendocrinology, neuroplasticity, and the autonomic nervous system. In this model, fatigue can be understood as an evolutionary, meaningful symptom protective of the organism.

Conclusions: A deeper understanding of the relationship between centralized pain syndrome and fatigue allows for new explanatory and treatment approaches.
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Open access in German at https://www.vr-elibrary.de/doi/10.13109/zptm.2018.64.4.365#.XIPVq9EuDUI
 
There is no need for "integrative explanatory approaches" for pain and fatigue. They are both signs of disease which sometimes happen together, sometimes separately.

When we know so little about the biochemical and physiological basis of either there seems little point in central sensitisation being invoked when there is so little valid evidence it exists or that the "new explanatory and treatment approaches", CBT and exercise, have any effect.
 
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