Thesis The association between pain catastrophizing and chronic fatigue in the general population: the HUNT pain study, 2023, Schjetne

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https://ntnuopen.ntnu.no/ntnu-xmlui/handle/11250/3080846

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https://hdl.handle.net/11250/3080846
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2023
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• Institutt for sirkulasjon og bildediagnostikk [1697]

The association between pain catastrophizing and chronic fatigue in the general population: the HUNT pain study
Schjetne, Julie
Master thesis

Abstract

Introduction: Fatigue and pain are common complaints in the community and may have many of the same underlying mechanisms. Pain catastrophizing is a predictor of adverse pain-related outcomes, but the relation to fatigue is not fully investigated. The aim of this study is to firstly investigate the association between pain catastrophizing and feeling of energy in the general population and the second aim is to see if pain catastrophizing is related to the occurrence of chronic fatigue.


Method: In the population-based HUNT pain study, a random sample of 6419 participants were invited to answer questions about how much energy they had during the last week, using the SF-8 vitality scale, every three months over a year. Multiple linear regression and logistic regression analyses were used to investigate the association between pain catastrophizing and individuals’ tendency to report energy over one year, and the association with chronic fatigue, respectively. Chronic fatigue was defined as a mean score of less than 2 which indicates reports of a little energy or less most of the time.


Results: The current sample (n=3965) consisted of individuals answering about the required variables and possible confounders. A significant association was found between pain catastrophizing and energy levels of the general population even after controlling for age, sex, organ-specific diseases, mental health, and pain intensity (β=0.04, 95% CI: 0.03-0.05). In the general population, 10% was defined as having chronic fatigue and odds increasing by 1.2 (95% CI: 1.1-1.3) for every unit increase in pain catastrophizing.


Conclusion: This study indicates that there is an association between pain catastrophizing and energy levels, and the association is even more apparent with chronic fatigue. According to models explaining fatigue and pain, pain catastrophizing may strengthen an imbalance of costs versus benefits in goal-directed behaviour. Moreover, it is proposed that fatigue can be included in the vicious circle described by the fear-avoidance model as a consequence of catastrophizing and maintaining pain.

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NTNU

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Introduksjon: Utmattelse og smerte er utbredte plager i samfunnet og kan ha mange av de samme underliggende mekanismene. Verstefallstenkning om smerte er en prediktor for negative smerterelaterte konsekvenser, men sammenhengen med utmattelse er ikke fullstendig undersøkt. Det første formålet med studien er å undersøke sammenhengen mellom verstefallstekning om smerte og følelsen av overskudd i den generelle befolkningen, og det andre formålet er å se om verstefallstenkning om smerte er relatert til forekomsten av kronisk utmattelse.



Metode: I den populasjonsbaserte studien smerte-HUNT ble et tilfeldig utvalg på 6419 deltagere invitert til å svare på spørsmål om hvor mye overskudd de hadde siste uken, ved bruk av SF-8 vitalitetsskala, hver tredje måned over ett år. Multiple lineære og logiske regresjonsanalyser ble brukt for å undersøke henholdsvis sammenhengen mellom verstefallstenkning og personers tendens til å rapportere overskudd over ett år, og assosiasjonen med kronisk utmattelse. Kronisk utmattelse ble definert som en gjennomsnittsscore på mindre enn 2 som indikerer rapportering av litt overskudd eller mindre over tid.


Resultater: Utvalget i studien (n=3965) bestod av personer som hadde svart på de nødvendige variablene og mulige konfundere. Det ble funnet en signifikant sammenheng mellom verstefallstenkning om smerte og overskudd i den generelle befolkningen, selv etter å ha kontrollert for alder, kjønn, organspesifikke sykdommer, mental helse og smerteintensitet (β=0.04, 95% CI: 0.03-0.05). I den generelle befolkningen ble 10% definert som å ha kronisk utmattelse og odds økende med 1.2 (95% CI: 1.1-1.3) for hver enhet økning i verstefallstenkning om smerte.


Konklusjon: Denne studien indikerer at det er en sammenheng mellom verstefallstekning om smerte og overskudd, og sammenhengen er enda mer tydelig med kronisk utmattelse. Ifølge forklaringsmodeller for utmattelse og smerte kan verstefalltenkning om smerte mulig forsterke ubalansen mellom kostnader og nytte i målrettet adferd. Det foreslåes at utmattelse kan inkluderes i den onde sirkelen beskrevet i frykt-unngåelsesmodellen som en konsekvens av verstefallstenking og opprettholdelse av smerte.

 

[Arnie Pye]

It seems that the authors assume being in pain = pain catastrophizing.

They are not even looking at correlations (which don't imply causation anyway) they are looking at associations.

Being in pain is exhausting, so no wonder it causes fatigue.

I've thought many times that the people doing this type of research have never been in more pain than would occur after stubbing your toe on a pillow.

 

[rvallee]

I can't believe that some Master's degrees can be gotten this easily. It degrades the value for everyone who actually had to put some effort into it. Pain catastrophizing is completely subjective to a 3rd party, has zero value and is nothing but a moral judgment of other people's behavior.

 

[Hutan]

Master’s thesis in Clinical Health Science - Pain and Palliative Care Supervisor: Tormod Landmark
May 2023
Norwegian University of Science and Technology

Tormod Landmark - is there some relationship with Live Landmark?

I know this is a Masters thesis, and English is a second language, and we should be kind, but this is really awful. The supervisor should be ashamed.

Women, the ones with children, and people from lower educational or occupational groups appear to have higher levels of fatigue (Jason, Jordan et al., 1999).

Lower socioeconomic status is one social component involved in both chronic pain and chronic fatigue (Gatchel et al., 2007; Jason, Jordan et al; 1999).

There are obvious reasons why people who are poor and doing manual work might be exhausted and in pain, and why people with fatigue and pain might be poor. But so far, these aren't mentioned, while highly questionable theories are.

The first indication of fatigue is found in the medical literature in the 1870s referred to as overwork due to loss of mental energy (Rabinbach, 1990)....
Late in the 1980s the Epstein- Barr virus syndrome increased the focus on fatigue. This was later renamed to chronic fatigue syndrome (CFS) (Wesseley, 1997).

It seems the industrial revolution was responsible for fatigue being a thing - with workers no longer feeling in control of their work.

Throughout the years several theories of pain have been evolved. The first description of pain is from over 3000 years ago in an ancient medical book from Chinese medicine. Pain was believed to be a result of an imbalance between yin and yang (Chen, 2011).

Whereas pain has been around longer.

About 0.2-0.4% of the general population have chronic fatigue syndrome (Nacul et al., 2011; Jason, Richman et al., 1999), meaning fatigue lasting at least six months including additional symptoms such as impaired memory or concentration, sleep disturbance, muscle pain etc (Fukuda et al., 1994). To determine this diagnosis there are strong exclusion criteria and if another medical or psychiatric cause of chronic fatigue is found, the person will be excluded from having the diagnosis (Fukuda et al., 1994).

Of course Fukuda. No mention of PEM. BPS proponents seem to have no problems with people having both ME/CFS and depression.

Acute fatigue or short-term fatigue has a normal protective function in the body. It lasts under three months, has usually a clearly identifiable cause and will withdraw with rest or by treating the underlying condition (Jason et al., 2010). Chronic fatigue is an abnormal, more persistent, fatigue. The debut is gradual, it persists over time and is normally multifactorial in aetiology. It is generally not relieved with normal resting. It affects the quality of life and daily activities negatively (Aaronson et al., 1999). Chronic fatigue usually starts with decreased physical activity levels. Many cancer patients report inference on the activities they used to do; they lose control over some parts of what their lives used to consist of. Further, it may contribute to the feeling of loneliness and/or isolation. This negative spiral will further decrease their distressing position (Flechtner & Bottomley, 2003).

I fail to see why someone who is working hard and getting little sleep has acute fatigue, but, when that same person has been experiencing that for 3 months, it suddenly morphs into something different, with a different aetiology and not amenable to resolution by resting. And a gradual debut for chronic fatigue? Surely all fatigue suddenly becomes chronic at the three month mark?

Chronic fatigue is a known symptom in the aftermath of infectious diseases (White et al., 2001; Seet et al., 2001; Hanevik et al., 2014).

How does a debut after an infectious disease fit with a gradual debut?

Due to a systematic review of the coexistence of pain and fatigue by Fishbain and colleagues (2003), it is found in prospective studies that fatigue is developed after the pain onset.

I don't think that's how it works in ME/CFS. But sure, chronic pain might cause sleeplessness or make daily life more effortful. This thesis is such a muddle of things. A lot of problems come from assuming that ME/CFS is primarily just chronic fatigue that is not attributable to another cause.

Both chronic pain and fatigue is related to compromised executive control (Moriarty et al., 2011; Van der Linden et al., 2003). This can lead to a circle of maintained fatigue. Established theories as the fear-avoidance model can explain the elevated pain expectations for a task to interpret pain in an excessively negative way (Vlaeyen & Linton, 2012). This this can further lead to fatigue due to an imbalanced costs-benefit trade-off.

High levels of fear avoidance are found in 40% of patients with fibromyalgia (Turk et al., 2004) and even though the literature is indicating that fear avoidance is prevalent in CFS, the prevalence data is not clear (Nijs et al., 2013).

Just, ugh.

The reason I started reading was I wanted to find out how they defined pain catastrophising in the study. But there was so many questionable statements. I've only got to section 1.4 and I've run out of enthusiasm for now. Perhaps it's fear avoidance, perhaps it is breakfast time.

 

[Trish]

I notice how old most of the references are. And the idea that fatigue started with the industrial revolution is completely bizarre. Oh dear, and this sort of nonsense earns a Masters' degree?

 

[RedFox]

Anyone who writes about pain catastrophizing deserves a cat ass trophy.

 

[Shadrach Loom]

Masters level work shouldn’t be published any more than undergraduate essays are. It’s a passport to doctoral research, not a purported contribution to human understanding, and of course it looks woefully threadbare to anyone with a longstanding interest in the subject at hand.

I would definitely agree that the supervisor deserves more blame than the author, but the institution and the publisher shouldn’t be doing this for anything dashed off by a callow youngster a year into postgraduate study, even on subjects which are less contentious. In a few years this poor sod will be trying to get a proper job somewhere, with theor youthful witterings - and online critiques - visible for all to see.

 

[Shadrach Loom]

Anyone who writes about pain catastrophizing deserves a cat ass trophy.

* applauds *

 

[Midnattsol]

Masters level work shouldn’t be published any more than undergraduate essays are. It’s a passport to doctoral research, not a purported contribution to human understanding, and of course it looks woefully threadbare to anyone with a longstanding interest in the subject at hand.

I would definitely agree that the supervisor deserves more blame than the author, but the institution and the publisher shouldn’t be doing this for anything dashed off by a callow youngster a year into postgraduate study, even on subjects which are less contentious. In a few years this poor sod will be trying to get a proper job somewhere, with theor youthful witterings - and online critiques - visible for all to see.

In Norway it is common to have both bachelor and master level theses published at the university's own pages.

Funny that acute undernutrition and acute chronic fatigue has the same timeframe of three months. Though with undernutrition there seems to be a move away from this since the word "acute" together with "three months" just doesn't make much sense.

There is a relation between Tormod and Live @Hutan, but I can't remember what at the moment. @Kalliope ?

 

[Shadrach Loom]

In Norway it is common to have both bachelor and master level theses published at the university's own pages.

Well, I hope there is an erasure provision under GDPR. If anything deserves to be forgotten, it is juvenilia.

 

[Kalliope]

There is a relation between Tormod and Live @Hutan, but I can't remember what at the moment. @Kalliope ?

Sorry. No idea..

 

[Hutan]

Masters level work shouldn’t be published any more than undergraduate essays are. It’s a passport to doctoral research, not a purported contribution to human understanding, and of course it looks woefully threadbare to anyone with a longstanding interest in the subject at hand.

I would definitely agree that the supervisor deserves more blame than the author, but the institution and the publisher shouldn’t be doing this for anything dashed off by a callow youngster a year into postgraduate study, even on subjects which are less contentious. In a few years this poor sod will be trying to get a proper job somewhere, with theor youthful witterings - and online critiques - visible for all to see.

I understand what you are saying, but I think I disagree. I've seen fine work done at the honours and Masters level. And, although papers are frequently published as a result of the research, the thesis often has a lot more detail and information than the paper.

Of course we should give young researchers some leeway and understanding, but what is written reflects what they have learned, what they think is acceptable and what they will take out into the world. More to the point, it reflects what the supervisor has allowed them to produce. Ignorant stuff like this amounts to hate speech and causes considerable harm. I think it's important to know which institutions and academics are facilitating this.

 

[Shadrach Loom]

I understand what you are saying, but I think I disagree. I've seen fine work done at the honours and Masters level. And, although papers are frequently published as a result of the research, the thesis often has a lot more detail and information than the paper.

Of course we should give young researchers some leeway and understanding, but what is written reflects what they have learned, what they think is acceptable and what they will take out into the world. More to the point, it reflects what the supervisor has allowed them to produce. Ignorant stuff like this amounts to hate speech and causes considerable harm. I think it's important to know which institutions and academics are facilitating this.

That last point is definitely a solid public interest argument.