Physical and Psychological Correlates of Fatigue and Physical Function: A Collaborative Health Outcomes Information Registry (CHOIR) Study

  • John A. Sturgeon
    Address reprint requests to John A. Sturgeon, PhD, Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA 94304.
    Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, California
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  • Beth D. Darnall
    Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, California
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  • Ming-Chih J. Kao
    Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, California
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  • Sean C. Mackey
    Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, California
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Published:December 20, 2014DOI:


      • Data were sampled from an open-source data registry in a tertiary care pain clinic.
      • PROMIS measures were used to assess physical and psychological functioning.
      • Path analysis techniques were used to model statistical relationships.
      • Pain intensity, sleep disturbance, and depression uniquely contribute to fatigue.
      • Fatigue is a mediator between pain and both physical function and pain interference.


      Fatigue is a multidimensional construct that has significant implications for physical function in chronic noncancer pain populations but remains relatively understudied. The current study characterized the independent contributions of self-reported ratings of pain intensity, sleep disturbance, depression, and fatigue to ratings of physical function and pain-related interference in a diverse sample of treatment-seeking individuals with chronic pain. These relationships were examined as a path modeling analysis of self-report scores obtained from 2,487 individuals with chronic pain from a tertiary care outpatient pain clinic. Our analyses revealed unique relationships of pain intensity, sleep disturbance, and depression with self-reported fatigue. Further, fatigue scores accounted for significant proportions of the relationships of both pain intensity and depression with physical function and pain-related interference and accounted for the entirety of the unique statistical relationship between sleep disturbance and both physical function and pain-related interference. Fatigue is a complex construct with relationships to both physical and psychological factors that has significant implications for physical functioning in chronic noncancer pain. The current results identify potential targets for future treatment of fatigue in chronic pain and may provide directions for future clinical and theoretical research in the area of chronic noncancer pain.


      Fatigue is an important physical and psychological variable that factors prominently in the deleterious consequences of pain intensity, sleep disturbance, and depression for physical function in chronic noncancer pain.

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