Care at the Close of Life: Evidence and Experience
Stephen J. McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat, Amy J. Markowitz
Part B Symptom Management
Chapter 9. Palliative Management of Fatigue at the Close of Life: “It Feels Like My Body Is Just Worn Out”
Sriram Yennurajalingam, MD, Eduardo Bruera, MD
Pain and Opioid-Induced Neurotoxicity Contributing to Fatigue
Topics Discussed:
anemia, cognitive impairment, criterion standard comparisons (diagnostic tests), delirium, diagnostic process, fatigue, fatigue assessment, neurotoxicity syndromes, opioid-related disorder, pain, weight reduction
Excerpt:
"Fatigue's multidimensional character makes systematic
evaluation essential.3 Fatigue assessment involves
characterizing its severity, temporal features (onset, course, duration,
and daily pattern), exacerbating and relieving factors, associated
distress, and impact on daily life4 and identifying
treatable causes. Several scales have been developed to quantify
fatigue in initial assessment and to monitor symptoms over time
(Table 9-1). Although most scales were developed for patients
with cancer, the Edmonton Symptom Assessment Scale has been validated
in elderly palliative care patients and has reliability similar
to the other tools.30-41Fatigue is frequently noted in studies of chronic low back pain
and neck pain.45 In a structured, evidence-based
study of the pain-fatigue literature, Fishbain et al45 reviewed
high-quality studies enrolling patients with many kinds of chronic
pain, including pain due to osteoarthritis, rheumatoid arthritis,
ankylosing spondylitis, fibromyalgia, cancer, chronic headache,
and chronic low back pain. In these studies, grade A evidence (highly
consistent findings from multiple studies) indicated an association
between pain and fatigue and suggested that, at least in some patient
populations, persistent pain can be considered a causative factor...."
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