Although a common mechanism may drive fatigue, any application of common frameworks for purposes of intervention must take into account the multidimensional nature of fatigue as captured by fatigue questionnaires measuring physical, cognitive, and psychosocial dimensions of fatigue ( Hewlett and others 2011), with a detailed discussion of the many dimensions of fatigue found elsewhere ( Christensen and others 2008 Flinn and Stube 2010 Hagelin and others 2009 Joyner 2016 Whitehead and others 2016). This is best captured by the definition proposed by Chaudhuri and Behan (2004), who describe fatigue as “a feeling arising from difficulty in initiation of or sustaining voluntary effort.” Here the focus is on voluntary effort without reference to domain specificity, therefore, be it fatigue triggered by physical or cognitive effort, effort is the common denominator, thereby any changes in effort related processing will result in fatigue. This raises a very important question that impacts on how we investigate and treat fatigue-Is fatigue a single construct? Is there more than one form of fatigue? Although fatigue is multidimensional, possibly requiring multiple strategies to combat it, the notion of a common mechanism underpinned by dysfunction in a fundamental property of brain processing is nevertheless conceivable. Moreover, almost everyone who suffers from depression, chronic pain, or sleep disturbances report fatigue, but a significant number with fatigue do not present with other problems. The strongest evidence for fatigue being independent comes from the lack of effect of antidepressants on fatigue, with some making fatigue worse. Failure of treatments targeting the supposed primary problem to reduce fatigue lead to the gradual realization that fatigue is a primary problem driven by partially independent mechanisms. A key reason being fatigue co-occurs with a wide variety of other affective symptoms and consequently thought to be a secondary symptom. Fatigue, the Cinderella of Affective SymptomsĬhronic, irreversible fatigue is a distressing symptom in several neurological conditions ( Chaudhuri and Behan 2004 Penner and Paul 2017), yet until recently very little was known about what might cause such fatigue.
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