The term functional somatic syndrome has been applied to several related syndromes characterized more by symptoms, suffering, and disability than by consistently demonstrable tissue abnormality. These syndromes include multiple chemical sensitivity, the sick building syndrome, repetition stress injury, the side effects of silicone breast implants, the Gulf War syndrome, chronic whiplash, the chronic fatigue syndrome, the irritable bowel syndrome, and fibromyalgia. Patients with functional somatic syndromes have explicit and highly elaborated self-diagnoses, and their symptoms are often refractory to reassurance, explanation, and standard treatment of symptoms. They share similar phenomenologies, high rates of co-occurrence, similar epidemiologic characteristics, and higherthan-expected prevalences of psychiatric comorbidity. Although discrete pathophysiologic causes may ultimately be found in some patients with functional somatic syndromes, the suffering of these patients is exacerbated by a self-perpetuating, self-validating cycle in which common, endemic, somatic symptoms are incorrectly attributed to serious abnormality, reinforcing the patient’s belief that he or she has a serious disease. Four psychosocial factors propel this cycle of symptom amplification: the belief that one has a serious disease; the expectation that one’s condition is likely to worsen; the “sick role,” including the effects of litigation and compensation; and the alarming portrayal of the condition as catastrophic and disabling. The climate surrounding functional somatic syndromes includes sensationalized media coverage, profound suspicion of medical expertise and physicians, the mobilization of parties with a vested self-interest in the status of functional somatic syndromes, litigation, and a clinical approach that overemphasizes the biomedical and ignores psychosocial factors. All of these influences exacerbate and perpetuate the somatic distress of patients with functional somatic syndromes, heighten their fears and pessimistic expectations, prolong their disability, and reinforce their sick role. A six-step strategy for helping patients with functional somatic syndromes is presented here. This paper is also available at http://www.acponline.org.

Functional Somatic Syndromes

Objective: The objective of this study was to estimate fatigue prevalence and associated health-related lost productive time (LPT) in U.S. workers. Methods: Fatigue prevalence, LPT due to fatigue, and LPT for any health-related reason (in hours and dollars) were measured in a national cross-sectional telephone survey of U.S. workers. Results: The 2-week period prevalence of fatigue was 37.9%. Of workers with fatigue, 65.7% reported health-related LPT compared with 26.4% of those without fatigue. Workers with fatigue cost employers $136.4 billion annually in health-related LPT, an excess of $101.0 billion compared with workers without fatigue. Fatigue frequently co-occurs with other conditions and, when present, is associated with a threefold increase, on average, in the proportion of workers with condition-specific LPT. Conclusions: Fatigue is prevalent in the U.S. workforce. When occurring with other health conditions, it is associated with significantly more condition-specific LPT. (J Occup Environ Med. 2007;49:1–10)

/pdf/fatigue-in-the-u-s-workforce-prevalence-and-implications-for-21v4dli2jr.pdf

Fatigue in the U.S. workforce: prevalence and implications for lost productive work time.

Background: Our goals were to determine the prevalence of unusual, debilitating fatigue and the frequency with which it was associated with the chronic fatigue syndrome (CFS) or other physical or psychological illness in an outpatient clinic population. Methods: We prospectively evaluated a cohort of 1000 consecutive patients in a primary care clinic in an urban, hospital-based general medicine practice. The study protocol included a detailed history, physical examination, and laboratory and psychiatric testing. Results: Five patients who came because of CFS studies were excluded. Of the remaining 995,323 reported fatigue, and 271 (27%) complained of at least 6 months of unusual fatigue that interfered with their daily lives. Of the 271, self-report or record review revealed a medical or psychiatric condition that could have explained the fatigue in 186 (69%). Thus, 85 (8.5%) of 995 patients had a debilitating fatigue of at least 6 months' duration, without apparent cause. Of these patients, 48 refused further evaluation, and 11 were unavailable for follow-up; 26 completed the protocol. Three of the 26 were hypothyroid, and one had a major psychiatric disorder. Of the remaining 22 patients, three met Centers for Disease Control and Prevention criteria for CFS, four met British criteria, and 10 met the Australian case definition. The point prevalences of CFS were thus 0.3% (95% confidence interval [CI], 0% to 0.6%), 0.4% (95% CI, 0% to 0.8%), and 1.0% (95% CI, 0.4% to 1.6%) using the Centers for Disease Control and Prevention, British, and Australian case definitions, respectively. These estimates were conservative, because they assumed that none of the patients who refused evaluation or were unavailable for follow-up would meet criteria for CFS. Conclusions: While chronic, debilitating fatigue is common in medical outpatients, CFS is relatively uncommon. Prevalence depends substantially on the case definition used. (Arch Intern Med. 1993;153:2759-2765)

Prevalence of Fatigue and Chronic Fatigue Syndrome in a Primary Care Practice

This review summarizes the symptoms and signs seen in patients with chronic fatigue syndrome (CFS). It is based on the authors' experience with two cohorts of approximately 510 patients with chronic debilitating fatigue and on the reported experience of other investigators with similar patients. The most characteristic symptoms of CFS are the sudden onset of an infectious-type illness, the subsequent chronic and debilitating fatigue, and postexertional malaise; many patients also have recurrent fevers, pharyngitis, adenopathy, myalgias, sleep disorders, and cognitive impairment.

Symptoms and signs of chronic fatigue syndrome.

Impact of fatigue on the quality of life of patients with primary biliary cirrhosis.

The medical records of 176 patients with an isolated diagnosis of fatigue (ICHPPC-7901) were reviewed. The study population represented the experience of four family physicians in private practice and of residents and staff of a university family medicine center in Denver, Colorado, over a 12-month period. Variables included for study were age, sex, family structure, diagnostic testing, duration of symptoms, and associated final diagnosis. Women outnumbered men in the study population two to one. Fatigue occurred most frequently in people ages 15 to 34 years. Single people, both men and women, were represented in the study population at a higher rate than family members. Single women tended to have physical diagnoses associated with their fatigue, while women who were members of family units tended to have psychological diagnoses associated. Fatigue lasting longer than four months was more frequently associated with psychological problems, while symptoms less than four months in duration were more frequently associated with physical problems. Physical problems were involved in just over half the cases, with the most common being the prolonged viral syndrome. A discussion with the patient regarding his or her fatigue and its origin was documented in only about half of the cases.

Fatigue as a presenting complaint in family practice.

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Fatigue as a presenting complaint in family practice.