Chronic Fatigue, Chronic Fatigue Syndrome, and Fibromyalgia: Disability and Health-Care Use
Abstract
OBJECTIVES: Disabling chronic fatigue that does not meet criteria for chronic fatigue syndrome (CFS) or fibromyalgia (FM) is a condition thought to be associated with substantial disability and an apparently high use of health-care services. The authors compare patients who have chronic fatigue, CFS, FM, or CFS and FM together (CFS+FM) on employment status, self-reported disability, number of medical care visits, type of services obtained, and other diagnoses received. METHODS: The authors studied 402 patients from a university-based chronic fatigue clinic. All patients underwent an initial structured diagnostic assessment. One hundred forty-seven patients met case criteria for CFS, 28 for FM, 61 for CFS+FM, and 166 fell in the residual chronic fatigue group. Of these patients, 388 completed a follow-up questionnaire an average of 1.7 years later. Chi-squared tests and analysis of variance were used to compare groups on follow-up measures of health-care use and disability. RESULTS: Patients with chronic fatigue, CFS, FM, and CFS+FM were similar in terms of disability and health-care use, though those with CFS+FM were significantly more likely to be unemployed and to use more chiropractic and "other" provider services. Rates of unemployment ranged from 26% (chronic fatigue) to 51% (CFS+FM). Overall, patients reported a mean of 21 visits to a wide variety health-care providers during the previous year, with no significant differences between groups. CONCLUSIONS: Chronic fatigue, CFS, and FM are associated with considerable personal and occupational disability and low rates of employment. The potentially large economic burden of these disorders underscores the need for accurate estimates of direct and indirect costs, the relative contribution of individual factors to disability, and the need to develop targeted rehabilitation programs.
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Between 35% and 50% of patients with fibromyalgia were not working.
“questionnaire-based studies have found that between 35% and 50% of patients with fibromyalgia were not working.2–5”
From Does work have to be so painful? A review of the literature examining the effects of fibromyalgia on the working experience from the patient perspective (2020) · cites this paper as [2]
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“patients from a university-based chronic fatigue clinic, it was found that 27% of CFS patients visited chiropractors, and 12% visited osteopaths (Bombardier and Buchwald, 1996).”
BackgroundDifferential-display PCR of peripheral blood for biomarker discovery in chronic fatigue syndrome
Steinau, M., Unger, E. R., Vernon, S. D., Jones, J. F., & Rajeevan, M. S. (2004) · Journal of Molecular Medicine · doi:10.1007/s00109-004-0586-4 · Cited by 47 · see citing works
“based [1, 2] and clinic-based studies [4, 5, 6] have doc-”
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Epidemiology: prevalence, causes and consequences
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“CFS/ME is associated with a high level of distress and disruption to patients lives, and is costly in terms of both health service utilization and economic burden to patients and their families [3-5].”
BackgroundBerger, A., Sadosky, A., Dukes, E., Martin, S., Edelsberg, J., & Oster, G. (2008) · Current Medical Research and Opinion · doi:10.1185/03007990802316550 · Cited by 40 · see citing works
Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome
Severens, J. L., Prins, J. B., van der Wilt, G. J., van der Meer, J. W. M., & Bleijenberg, G. (2004) · QJM · doi:10.1093/qjmed/hch029 · Cited by 40 · see citing works
“The economic burden related to the disability and health care use resulting from CFS underscores the need for analysis of the costs involved.(5) Cognitive behaviour therapy (CBT) can be considered to be an efficacious treatment for CFS, but in the first randomized controlled trials,(6,7) the therapy was administered b…”
BackgroundResultTaylor, R. R., & Kielhofner, G. (2005) · Journal of Mental Health · doi:10.1080/09638230500136571 · Cited by 39 · see citing works
“Three studies presented longitudinal follow-up data on employment status (Bombardier & Buchwald, 1996; Tiersky et al., 2001; Vercoulen & Bleijenberg, 1996).”
BackgroundPilkington, K., Ridge, D., Igwesi-Chidobe, C. N., Chew-Graham, C. A., Little, P. S., Babatunde, O. O., McDermott, C., & Cheshire, A. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113369 · Cited by 37 · see citing works
A twin study of cognitive function in chronic fatigue syndrome: The effects of sudden illness onset.
Claypoole, K. H., Noonan, C., Mahurin, R. K., Goldberg, J. H., Erickson, T., & Buchwald, D. (2007) · Neuropsychology · doi:10.1037/0894-4105.21.4.507 · Cited by 37 · see citing works
“Difficulties with memory dominate the complaints of patients with CFS (Bombardier & Buchwald, 1996), but objective evidence of memory impairment has been inconclusive (Marshall et al., 1997; Michiels & Cluydts, 2001; Tiersky et al., 1997).”
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“It results in a strong reduction in physical and mental functioning (Bombardier & Buchwald, 1996; Jason et al., 2000).”
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Strand, E. B., Mengshoel, A. M., Sandvik, L., Helland, I. B., Abraham, S., & Nes, L. S. (2018) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2018-0095 · Cited by 34 · see citing works
The Causal Role of Fatigue in the Stress-Perceived Health Relationship: A MetroNet Study
Juratli, S. M., Janisse, J. J., Schwartz, K., & Arnetz, B. B. (2010) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2010.02.090132 · Cited by 33 · see citing works
FUNCTIONAL STATUS, NEUROPSYCHOLOGICAL FUNCTIONING, AND MOOD IN CHRONIC FATIGUE SYNDROME (CFS)
Tiersky, L. A., Matheis, R. J., DeLuca, J., Lange, G., & Natelson, B. H. (2003) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000066155.65473.26 · Cited by 33 · see citing works
“Individuals with chronic fatigue syndrome (CFS) have a significantly reduced quality of life because of neuropsychological dysfunction, physical decline, and emotional distress (Bombardier and Buchwald, 1996; Buchwald et al., 1996; Komaroff et al., 1996; Moss-Morris et al., 1996; Myers and Wilks, 1999; Natelson et al.…”
BackgroundBarriers to healthcare utilization in fatiguing illness: a population-based study in Georgia
Lin, J.-M. S., Brimmer, D. J., Boneva, R. S., Jones, J. F., & Reeves, W. C. (2009) · BMC Health Services Research · doi:10.1186/1472-6963-9-13 · Cited by 31 · see citing works
“In spite of the burden imposed by CFS on individuals and the population, less than 20% of those with the illness have been diagnosed and received treatment [6,8].”
BackgroundPain in patients with chronic fatigue syndrome: Does nitric oxide trigger central sensitisation?
Nijs, J., de Velde, B. V., & Meirleir, K. D. (2004) · Medical Hypotheses · doi:10.1016/j.mehy.2004.07.037 · Cited by 30 · see citing works
Khanpour Ardestani, S., Karkhaneh, M., Stein, E., Punja, S., Junqueira, D. R., Kuzmyn, T., Pearson, M., Smith, L., Olson, K., & Vohra, S. (2021) · Medicina · doi:10.3390/medicina57070652 · Cited by 30 · see citing works
“Not surprisingly, ME/CFS reduces patients’ abilities to carry out normal working activities leading to higher unemployment rates [7].”
BackgroundChronic Fatigue Syndrome: Occupation, Medical Utilization, and Subtypes in a Community-Based Sample
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Coping strategies in twins with chronic fatigue and chronic fatigue syndrome
Afari, N., Schmaling, K. B., Herrell, R. K., Hartman, S. C., Goldberg, J. H., & Buchwald, D. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(00)00093-3 · Cited by 29 · see citing works
Self-citationDoes psychological vulnerability determine health-care utilization in fibromyalgia?
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Chronic fatigue and chronic fatigue syndrome: A co-twin control study of functional status
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“Other studies have also documented widespread impairments encompassing physical, emotional, and social aspects of functioning in these conditions [3, 5, 6, 23, 24].”
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“CFS/ME is a condition that is very debilitating both in terms of severity and duration of illness [9, 10].”
BackgroundAll Fatigue is Not Created Equal
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Gray Matter Volumes in Patients with Chronic Fatigue Syndrome
Tang, L., Zheng, H., Chen, L., Zhou, S., Huang, W., Li, Y., & Wu, X. (2015) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2015/380615 · Cited by 26 · see citing works
- Authors
- BOMBARDIER, C. H., & BUCHWALD, D.
- Affiliations
- University of Washington (US)
- Venue
- Medical Care
- Published
- 1996-09
- Volume
- 34
- Issue
- 9
- Pages
- 924-930
- ISSN
- 0025-7079 (ISSN-L)
- OpenAlex
- W2077888723
- Cited by
- 211
- References
- 18
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 5 · 2018: 4 · 2017: 3 · 2016: 4 · 2015: 6 · 2014: 4 · 2013: 5 · 2012: 4
- FWCI
- 2.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01ai026788-03, 5r01ag008240-03)
- National Institute on Aging (R01 AG08240)
- National Institute of Allergy and Infectious Diseases (R01 AI26788)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- chronic fatigue, chronic fatigue syndrome, fibromyalgia, employment status, disability, health care utilization, chiropractic services, economic burden, rehabilitation
- MeSH terms
- Adult, Analysis of Variance, Chronic Disease, Employment, Fatigue, Female, Fibromyalgia, Follow-Up Studies, Persons with Disabilities, Health Services, Health Services Research, Humans, Male, Middle Aged, Surveys and Questionnaires, Washington, Fatigue Syndrome, Chronic, Chi-Square Distribution, Health Care Costs
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