Approach to the adult patient with fatigue
- Kevin M Fosnocht, MD
Kevin M Fosnocht, MD
- Chief Medical Officer
- Associate Executive Director
- Penn Presbyterian Medical Center
- University of Pennsylvania Health System
- Jack Ende, MD
Jack Ende, MD
- Professor of Medicine
- University of Pennsylvania School of Medicine
Fatigue is a common complaint, with a prevalence in population-based surveys in Britain and the United States of between 6.0 and 7.5 percent [1,2]. A cross-sectional survey of United States workers found the two-week period prevalence of fatigue to be 38 percent, with an estimated annual cost to employers exceeding $136 billion in lost productive work time . In addition, an estimated 21 to 33 percent of patients seeking attention in primary care settings report significant fatigue [4-8], resulting in approximately seven million office visits per year in the United States .
The overall approach to the patient who complains of fatigue is presented here. Chronic fatigue syndrome (CFS), also known as systemic exertion intolerance disease (SEID), is discussed separately. (See "Clinical features and diagnosis of chronic fatigue syndrome (systemic exertion intolerance disease)" and "Treatment of chronic fatigue syndrome (systemic exertion intolerance disease)".)
Fatigue can be manifested as difficulty or inability initiating activity (perception of generalized weakness); reduced capacity maintaining activity (easy fatigability); and difficulty with concentration, memory, and emotional stability (mental fatigue) .
Fatigue should be distinguished from somnolence, dyspnea, and muscle weakness, although these symptoms may also be associated with fatigue. Patients may use the terms fatigue, tiredness, lack of energy, and excessive sleepiness interchangeably. (See "Approach to the patient with excessive daytime sleepiness" and "Approach to the patient with dyspnea" and "Approach to the patient with muscle weakness".)
Duration of fatigue can be recent (less than one month), prolonged (more than one month), or chronic (over six months). The presence of chronic fatigue does not necessarily imply the presence of chronic fatigue syndrome (CFS), also known as systemic exertion intolerance disease (SEID), which is discussed separately. (See "Clinical features and diagnosis of chronic fatigue syndrome (systemic exertion intolerance disease)".)
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- EPIDEMIOLOGY AND ETIOLOGY
- Systemic exertion intolerance disease (chronic fatigue syndrome)
- Idiopathic chronic fatigue
- Physical examination
- Laboratory studies
- Cognitive behavioral therapy
- Graded exercise therapy
- Other measures
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS