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. 2018 Jul;20(4):410-421.
doi: 10.1177/1099800418764326. Epub 2018 Mar 14.

A Systematic Review of Biological Mechanisms of Fatigue in Chronic Illness

Lea Ann Matura  1 , Susan Malone  1 , Rosario Jaime-Lara  1 , Barbara Riegel  1
Affiliations

A Systematic Review of Biological Mechanisms of Fatigue in Chronic Illness

Lea Ann Matura et al. Biol Res Nurs. 2018 Jul.

Abstract

Fatigue, a commonly reported symptom, is defined as an overwhelming, debilitating, and sustained sense of exhaustion that decreases the ability to function and carry out daily activities. To date, cancer researchers have been in the forefront in investigating the possible biological mechanisms of fatigue, identifying inflammation, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, and activation of the autonomic nervous system. The purpose of this systematic review is to describe fatigue and what is known about the biological mechanisms described in cancer in five chronic, noninfectious illnesses: heart failure, multiple sclerosis, chronic kidney disease, rheumatoid arthritis, and chronic obstructive pulmonary disease. We searched PubMed and EMBASE using fatigue as a major Medical subject headings (MeSH) heading with each individual disease added as a search term followed by each biological mechanism. We included only primary research articles published in English between 1996 and 2016 describing studies conducted in adult humans. We identified 26 relevant articles. While there is some evidence that the biological mechanisms causing fatigue in cancer are also associated with fatigue in other chronic illnesses, more research is needed to explore inflammation, the HPA axis, and the autonomic nervous system, and other mechanisms in relation to fatigue in a variety of chronic illnesses.

Keywords: autonomic nervous system; chronic kidney disease; chronic obstructive pulmonary disease; fatigue; heart failure; hypothalamic–pituitary–adrenal axis; inflammation; multiple sclerosis; rheumatoid arthritis.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Chronic illnesses are associated with underlying biological changes (inflammation, autonomic nervous system activation, and hypothalamic–pituitary–adrenal axis dysregulation) that appear to be associated with fatigue. These biological changes can be influenced by patient characteristics and modifiable factors. The cascade of biological processes illustrated in this figure can impact cognitive behavioral factors and impair physical function, activity, and energy balance, which can likewise affect levels of fatigue.
Figure 2.
Figure 2.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. COPD = chronic obstructive pulmonary disease.
See this image and copyright information in PMC

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