Differential Fatigue Profile in Patients with Post-COVID Condition, Fibromyalgia, and Multiple Sclerosis, 2025, Silvia Oliver-Mas et al

Mij

Mij

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Abstract
Background/Objectives: Fatigue is a prevalent and debilitating symptom in Post-COVID Condition (PCC), fibromyalgia, and multiple sclerosis (MS). Although these conditions share clinical similarities, the underlying mechanisms of fatigue across these conditions may differ and remain poorly understood.

This study aimed to compare the intensity and characteristics of fatigue in these three conditions to identify shared and distinct features.

Methods: We conducted a cross-sectional study involving 429 participants: 219 with PCC, 112 with fibromyalgia, and 98 with MS. Participants completed a questionnaire specifically developed for the study via the Google Forms platform. This questionnaire was developed by a group of professionals in the hospital specializing in fatigue related to these three conditions, in collaboration with expert patients. The questionnaire was reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) recommendations.

Results: Fatigue intensity was significantly higher in PCC and fibromyalgia compared to MS. Some differences in fatigue characteristics were observed: MS patients reported more fatigue in response to heat and a greater impact of mood on fatigue. Furthermore, delayed fatigue and reduced benefits from rest were more pronounced in both PCC and fibromyalgia. No significant differences were found regarding cognitive fatigue or difficulties in predicting the ability to perform activities.

Conclusions: These results underscore some clinical characteristics in the intensity and quality of fatigue across PCC, fibromyalgia, and MS.

These findings could suggest different mechanisms in the pathophysiology of the fatigue. Our study underscores the need for tailored diagnostic tools and interventions in managing fatigue in these three conditions.
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The only benefit of this study is that it talks about LC and FM at the same time as something more acceptable like MS.

The BPS lobby will probably spin this as «the mind can cause more fatigue than MS!»
 
In PCC, fatigue is also linked to peripheral mechanisms including structural and functional muscle damage. This aligns with the results of the present study because PCC reported greater muscle weakness and muscle pain. Likewise, patients with fibromyalgia report that fatigue is often accompanied by muscle pain. This interplay suggests that pain may exacerbate the sensation of fatigue in fibromyalgia. Previous research has also highlighted a strong connection between fatigue and pain in fibromyalgia. Moreover, the higher intensity of fatigue in PCC and fibromyalgia could also explain why these two groups experience fewer benefits of rest than MS and are more likely to develop delayed fatigue after physical or cognitive activity, a phenomenon previously linked to fatigue intensity. In this regard, we found that post-exertional malaise was more severe in PCC and fibromyalgia than MS, but not after controlling for fatigue severity. This suggests that this symptom may be a marker of severity, but it is not specific to any disorder.
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Again there seems to be confusion about what PEM is, framing it as post-exertional fatigue.
 
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