Chronic Fatigue Syndrome and Chronic Widespread Pain in Adolescence: Population Birth Cohort Study.
Chronic Fatigue Syndrome and Chronic Widespread Pain in Adolescence: Population Birth Cohort Study.
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DOI：
10.1016/j.jpain.2016.10.016
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发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Crawley E
中科院分区：
文献类型：
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作者：
Norris T;Deere K;Tobias JH;Crawley E
尽管许多研究调查了成人疼痛表型与慢性疲劳综合征 (CFS) 之间的重叠，但人们对青少年这些病症之间的关系知之甚少。因此，该研究的目的是确定青少年慢性广泛性疼痛 (CWP) 和 CFS 之间是否存在关系，并调查两者是否与一组协变量存在共同关联。雅芳父母和儿童纵向研究 (ALSPAC) 的后代在 17 岁时接受了一份问卷调查，询问部位、持续时间和疼痛强度，从中识别出患有 CWP 的参与者。在同一研究诊所，填写了基于计算机的修订临床访谈表，从中获得了 CFS 的分类。使用各种逻辑回归、序数逻辑回归和多项回归研究所选协变量与 CFS 和 CWP 之间的关系。我们确定了 3,214 名青少年，他们拥有所有结果和协变量的完整数据。有 82 人 (2.6%) 被归类为 CFS，145 人 (4.5%) 被归类为 CWP。 CFS 的分类导致 CWP 的可能性增加（比值比 = 3.87；95% 置信区间，2.05–7.31）。女性青少年患 CFS 或 CWP 的可能性大约是 CFS 的两倍，多项回归显示，与 CFS 相比，CWP 的性别影响更大。与无 CFS 的患者相比，患有纯 CFS 的患者更有可能报告更高水平的疼痛和更大的疼痛影响，尽管在调整协变量后相关性减弱至零，而这种情况在纯 CWP 患者中并未发生。多项回归显示，相对于既没有 CFS 也没有 CWP，抑郁和焦虑量表每增加 1 个单位，就会增加患有纯 CFS 的风险，并且在更大程度上增加患有 CFS 和 CWP 共病的风险，但不增加仅与焦虑相关的纯 CWP。在该队列中，14.6% 患有 CFS 的青少年患有 CWP。在这项流行病学研究中观察到的较轻病例的比例可能更大，这意味着与接受专科服务的病例相比，重叠的发生率可能被低估。临床医生应意识到这两种情况之间的重叠，并仔细考虑所提供的治疗方案。 14.6% 患有慢性疲劳综合症 (CFS) 的青少年患有慢性广泛性疼痛 (CWP)。女性青少年患有 CFS 或 CWP 的可能性是女性青少年的两倍。专属 CFS（与非 CFS 相比）与更高的疼痛和更大的疼痛影响相关。这种关联在协变量调整（抑郁、焦虑、肥胖）后减弱。较高的抑郁/焦虑症状与较高的 CFS 和 CWP 合并症几率相关。
Although many studies have investigated the overlap between pain phenotypes and chronic fatigue syndrome (CFS) in adults, little is known about the relationship between these conditions in adolescents. The study's aim was therefore to identify whether a relationship exists between chronic widespread pain (CWP) and CFS in adolescents and investigate whether the two share common associations with a set of covariates. A questionnaire was administered to offspring of the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 17, asking about site, duration, and pain intensity, from which participants with CWP were identified. At the same research clinic, a computer-based Revised Clinical Interview Schedule was filled out, from which a classification of CFS was obtained. The relationship between selected covariates and CFS and CWP was investigated using a variety of logistic, ordinal logistic, and multinomial regressions. We identified 3,214 adolescents with complete data for all outcomes and covariates. There were 82 (2.6%) individuals classified as CFS and 145 (4.5%) as CWP. A classification of CFS resulted in an increased likelihood of having CWP (odds ratio = 3.87; 95% confidence interval, 2.05–7.31). Female adolescents were approximately twice as likely to have CFS or CWP, with multinomial regression revealing a greater sex effect for CWP compared with CFS. Those with exclusive CFS were more likely to report higher levels of pain and greater effect of pain compared with those without CFS, although associations attenuated to the null after adjustment for covariates, which did not occur in those with exclusive CWP. Multinomial regression revealed that relative to having neither CFS nor CWP, a 1-unit increase in the depression and anxiety scales increased the risk of having exclusive CFS and, to a greater extent, the risk of having comorbid CFS and CWP, but not exclusive CWP, which was only related to anxiety. In this cohort, 14.6% of adolescents with CFS have comorbid CWP. The likely greater proportion of more mild cases observed in this epidemiological study means that prevalence of overlap may be underestimated compared with those attending specialist services. Clinicians should be aware of the overlap between the 2 conditions and carefully consider treatment options offered. 14.6% of adolescents with chronic fatigue syndrome (CFS) had chronic widespread pain (CWP). Female adolescents were twice as likely to have CFS or CWP. Exclusive CFS (vs non-CFS) was associated with higher pain and greater effect of pain. This association attenuated after covariate adjustment (depression, anxiety, obesity). Higher depressive/anxiety symptoms were linked with higher odds of comorbid CFS & CWP.