Volume 21 Issue 4
Apr.  2023
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ZHU Jiahong, LIU Ying, REN Jingjing. Diagnosis and treatment of medically unspecified disease manifested by fatigue: A general practice perspective[J]. Chinese Journal of General Practice, 2023, 21(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.002926
Citation: ZHU Jiahong, LIU Ying, REN Jingjing. Diagnosis and treatment of medically unspecified disease manifested by fatigue: A general practice perspective[J]. Chinese Journal of General Practice, 2023, 21(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.002926

Diagnosis and treatment of medically unspecified disease manifested by fatigue: A general practice perspective

doi: 10.16766/j.cnki.issn.1674-4152.002926


  • Received Date: 2022-11-07
    Available Online: 2023-05-31
  • Fatigue is a main reason for 10%-20% of all consultations with the general outpatient service. A survey showed that fatigue was the most common complaint among patients with medically unspecified diseases in offline general practice clinics in general hospitals. Also, a study found that fatigue could have a significant impact on patients' quality of life, and its severity was associated with mortality. As a common medically unspecified diseases, fatigue has no obvious specificity. It can not only be a normal physiological reaction of the human body, but also can be one of the manifestations of various diseases. Fatigue can be divided into physiological fatigue and pathological fatigue. Its etiology can be various and involve every system. It is difficult to evaluate and treat medically unspecified disease characterized by fatigue. Because of the subjective feeling, it is hard for general practitioners to evaluate the degree of fatigue. In addition to detailed history and physical examination, general practitioners need to objectively assess the degree of fatigue by using some assessment scales. However, there is no assessment scale for medically unspecified disease characterized by fatigue. The management of patients with medically unspecified disease characterized by fatigue includes symptomatic treatment (both non-pharmacological and pharmacological) and long-term follow-up to alleviate symptoms, relieve mood and reduce impairment in daily functioning. Further research is needed on how to provide a continuum of services for patients with fatigue, help some patients to live with their symptoms, and find effective interventions and treatments. We reviewed the literature on the general diagnosis and treatment of medically unspecified disease manifested by fatigue, hoping to help general practitioners with standardized diagnosis and continued management of the patient with fatigue.


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  • [1]
    娄铮, 刘颖, 任菁菁. 全科医生对未分化疾病诊治观点的质性研究[J]. 中国现代医生, 2022, 60(32): 16-19, 24. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202232028.htm

    LOU Z, LIU Y, REN J J. A qualitative study of general practitioners' views on the diagnosis and treatment of medically unspecified disease[J]. China Modern Docto, 2022, 60(32): 16-19, 24. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202232028.htm
    刘娟娟, 刘颖, 任菁菁. 常见未分化疾病的全科处理探讨[J]. 中国全科医学, 2015, 18(32): 3985-3987. DOI: 10.3969/j.issn.1007-9572.2015.32.021.

    LIU J J, LIU Y, REN J J. Study of the treatment of common undifferentiated diseases in general practice[J]. Chinese General Practice, 2015, 18(32): 3985-3987. DOI: 10.3969/j.issn.1007-9572.2015.32.021.
    MAISEL P, BAUM E, DONNER-BANZHOFF N. Fatigue as the chief complaint- epidemiology, causes, diagnosis, and treatment[J]. Dtsch Arztebl Int, 2021, 118(33-34): 566-576.
    邱艳, 任文, 刘颖, 等. 综合性医院全科线上-线下门诊就诊情况分析[J]. 中华医院管理杂志, 2018, 34(7): 552-555. doi: 10.3760/cma.j.issn.1000-6672.2018.07.007

    QIU Y, REN W, LIU Y, et al. Analysis on the features of outpatients between online and offline general practice clinics[J]. Chinese Journal of Hospital Administratio, 2018, 34(7): 552-555. doi: 10.3760/cma.j.issn.1000-6672.2018.07.007
    GLYNN N W, GMELIN T, RENNER S W, et al. Perceived physical fatigability predicts all-cause mortality in older adults[J]. J Gerontol A Biol Sci Med Sci, 2022, 77(4): 837-841. doi: 10.1093/gerona/glab374
    JAIME-LARA R B, KOONS B C, MATURA L A, et al. A qualitative metasynthesis of the experience of fatigue across five chronic conditions[J]. J Pain Symptom Manage, 2020, 59(6): 1320-1343. doi: 10.1016/j.jpainsymman.2019.12.358
    CALDWELL J A, CALDWELL J L, THOMPSON L A, et al. Fatigue and its management in the workplace[J]. Neurosci Biobehav Rev, 2019, 96: 272-289. doi: 10.1016/j.neubiorev.2018.10.024
    HUI HO D C, ZHENG R M. Approach to fatigue in primary care[J]. Singapore Med J, 2022, 63(11): 674-678. doi: 10.4103/SINGAPOREMEDJ.SMJ-2021-118
    张潇宇, 谢晓冬. 癌因性疲乏如何管理: 2019NCCN癌症相关性疲乏指南解读[C]//中国抗癌协会肿瘤标志专业委员会, 中国抗癌协会青年理事会. 2019年中国肿瘤标志物学术大会暨第十三届肿瘤标志物青年科学家论坛论文集, 武汉, 2019: 319.

    ZHANG X Y, XIW X D. How to manage cancer-caused fatigue-an explanation of the 2019 NCCN cancer-related fatigue guidelines[C]//2019 Chinese Congress on Oncology, Wuhan, 2019: 319.
    THONG M S Y, VAN NOORDEN C J F, STEINDORF K, et al. Cancer-related fatigue: causes and current treatment options[J]. Curr Treat Options Oncol, 2020, 21(2): 17. doi: 10.1007/s11864-020-0707-5
    MOSHER C E, SECINTI E, JOHNS S A, et al. Comparative responsiveness and minimally important difference of Fatigue Symptom Inventory (FSI) scales and the FSI-3 in trials with cancer survivors[J]. J Patient Rep Outcomes, 2022, 6(1): 82. doi: 10.1186/s41687-022-00488-1
    YANG S, CHU S, GAO Y, et al. A narrative review of Cancer-Related Fatigue (CRF) and its possible pathogenesis[J]. Cells, 2019, 8(7): 738. doi: 10.3390/cells8070738
    LV Z, GU Y M, LIU R D, et al. The clinical observation and mechanism of acupuncture on cancer-related fatigue of breast cancer based on "Gut-Brain Axis": study protocol for a randomized controlled trial[J]. Dis Markers, 2022, 2022: 8099595. DOI: 10.1155/2022/8099595.
    中华医学会肿瘤学分会肿瘤支持康复治疗学组. 中国癌症相关性疲乏临床实践诊疗指南(2021年版)[J]. 中国癌症杂志, 2021, 31(9): 852-872. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGAZ202109015.htm

    Tumor Support and Rehabilitation Therapy Group, the Oncology Committee of Chinese Medical Association. Clinical practice guidelines for cancer-related fatigue in China (2021 edition)[J]. China Oncology, 2021, 31(9): 852-872. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGAZ202109015.htm
    FABI A, BHARGAVA R, FATIGONI S, et al. Cancer-related fatigue: ESMO clinical practice guidelines for diagnosis and treatment[J]. Ann Oncol, 2020, 31(6): 713-723. doi: 10.1016/j.annonc.2020.02.016
    帅双亚, 姚宇红, 罗姗, 等. 观察补中益气汤对白血病患者乏力的干预效果[J]. 中西医结合心血管病电子杂志, 2020, 8(33): 170, 173. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH202033121.htm

    SHUAI S Y, YAO Y H, LUO S, et al. An observation of the intervention effect of fill in beneficial gas soup on weakness in leukemia[J]. Cardiovascular Disease Electronic Journal of integrated traditional Chinese and Western Medicine, 2020, 8(33): 170, 173. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH202033121.htm
    PERRIN R, RISTE L, HANN M, et al. Into the looking glass: Post-viral syndrome post COVID-19[J]. Med Hypotheses, 2020, 144: 110055. DOI: 10.1016/j.mehy.2020.110055.
    焦娟. 纤维肌痛综合征诊治进展[J]. 临床荟萃, 2019, 34(4): 293-298. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFC201904002.htm

    JIAO J. The overview of diagnosis and treatment of fibromyalgia syndrome[J]. Clinical Focus, 2019, 34(4): 293-298. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFC201904002.htm
    DEY M, PARODIS I, NIKIPHOROU E. Fatigue in systemic lupus erythematosus and rheumatoid arthritis: a comparison of mechanisms, measures and management[J]. J Clin Med, 2021, 10(16): 3566. doi: 10.3390/jcm10163566
    POPE J E. Management of fatigue in rheumatoid arthritis[J]. RMD Open, 2020, 6(1): e001084. DOI: 10.1136/rmdopen-2019-001084.
    TARASIUK J, KAPICA-YOPCZEWSKA K, CZARNOWSKA A, et al. Co-occurrence of fatigue and depression in people with multiple sclerosis: a mini-review[J]. Front Neurol, 2022, 12: 817256. DOI: 10.3389/fneur.2021.817256.
    VAES A W, GOERTZ Y M J, VAN HERCK M, et al. Physical and mental fatigue in people with non-communicable chronic diseases[J]. Ann Med, 2022, 54(1): 2522-2534.
    GOERTZ Y M J, BRAAMSE A M J, SPRUIT M A, et al. Fatigue in patients with chronic disease: results from the population-based lifelines cohort study[J]. Sci Rep, 2021, 11(1): 20977. DOI: 10.1038/s41598-021-00337-z.
    郭春霞. 基于步态分析的亚健康人群乏力的中医客观测评研究[D]. 北京: 中国中医科学院, 2020.

    GUO C X. Research on the objective evaluation of TCM for lassitude in sub-healthy population via gait analysis[D]. Beijing: China Academy of Chinese Medical Sciences, 2020.
    ENGBERG I, SEGERSTEDT J, WALLER G, et al. Fatigue in the general population- associations to age, sex, socioeconomic status, physical activity, sitting time and self-rated health: the northern Sweden MONICA study 2014[J]. BMC Public Health, 2017, 17(1): 654. doi: 10.1186/s12889-017-4623-y
    HINZ A, BENZING C, BRAHLER E, et al. Psychometric properties of the multidimensional fatigue inventory (MFI-20), derived from seven samples[J]. J Pain Symptom Manage, 2020, 59(3): 717-723. doi: 10.1016/j.jpainsymman.2019.12.005
    BAKALIDOU D, KROMMYDAS G, ABDIMIOTI T, et al. The Dimensionality of the multidimensional fatigue inventory (MFI-20) derived from healthy adults and patient subpopulations: a challenge for clinicians[J]. Cureus, 2022, 14(6): e26344. DOI: 10.7759/cureus.26344.
    李雯, 王爱霞, 冯娅婷. 有氧联合抗阻运动对食管癌化疗患者癌因性疲乏及生活质量的影响[J]. 肿瘤基础与临床, 2019, 32(1): 82-85. https://www.cnki.com.cn/Article/CJFDTOTAL-HLZL201901026.htm

    LI W, WANG A X, FENG Y T. Effects of aerobic combined with resistance exercise on cancer-related fatigue and quality of life in patients undergoing chemotherapy for esophageal cancer[J]. ournal of Basic and Clinical Oncolog, 2019, 32(1): 82-85. https://www.cnki.com.cn/Article/CJFDTOTAL-HLZL201901026.htm
    庄琦, 毛家亮, 李春波, 等. 躯体化症状自评量表的初步编制及信度和效度研究[J]. 中华行为医学与脑科学杂志, 2010, 19(9): 847-849.

    ZHUANG Q, MAO J L, LI C B, et al. Developing of somatic self-rating scale and its reliability and validity[J]. Chinese Journal of Behavioral Medicine and Brain Science, 2010, 19(9): 847-849.
    刘颖, 朱弘月, 贺颖, 等. 综合医院全科门诊中乏力患者特征及就诊原因分析[J]. 中国全科医学, 2020, 23(1): 92-95. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202001021.htm

    LIU Y, ZHU H Y, HE Y, et al. Features and consultation reasons in fatigue outpatients from the general practice department of a general hospital[J]. Chinese General Practice, 2020, 23(1): 92-95. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202001021.htm
    索仲, 方香香, 蔡丁. 基于家庭的多学科康复护理模式对肺癌化疗患者癌因性疲乏和生活质量的影响[J]. 癌症进展, 2021, 19(3): 309-312. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202103025.htm

    SUO Z, FANG X X, CAI D. Effect of family-based multidisciplinary rehabilitation nursing model on cancer-related fatigue and quality of life in patients with lung cancer chemotherapy[J]. Oncology Progress, 2021, 19(3): 309-312. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202103025.htm
    ZETZL T, RENNER A, PITTIG A, et al. Yoga effectively reduces fatigue and symptoms of depression in patients with different types of cancer[J]. Support Care Cancer, 2021, 29(6): 2973-2982. http://www.xueshufan.com/publication/3092568518
    钟紫外, 陆华东, 陆晨, 等. 共情式心理干预对自体DC/CIK细胞维持治疗肺腺癌患者癌因性疲乏、希望水平的影响[J]. 中华全科医学, 2018, 16(6): 1025-1028. doi: 10.16766/j.cnki.issn.1674-4152.000281

    ZHONG Z W, LU H D, LU C, et al. Effect of empathy mental intervention on the level of hope and cancer related fatigue in the nursing of autologous DC/CIK cells maintenance in the treatment of advanced pulmonary adenocarcinoma[J]. Chinese Journal of General Practice, 2018, 16(6): 1025-1028. doi: 10.16766/j.cnki.issn.1674-4152.000281
    王雁秋, 罗云, 陈思思. 中医治未病理论在慢性疲劳结合征防治中的应用[J]. 中国现代医生, 2021, 59(22): 148-151. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202122038.htm

    WANG Y Q, LUO Y, CHEN S S. Application of TCM theory of preventive treatment in the prevention and treatment of chronic fatigue syndrome[J]. China Modern Doctor, 2021, 59(22): 148-151. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202122038.htm
    HILFIKER R, MEICHTRY A, EICHER M, et al. Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis[J]. Br J Sports Med, 2018, 52(10): 651-658. http://pubmed.ncbi.nlm.nih.gov/28501804/
    BOLTON M J, CHAPMAN B P, VAN MARWIJK H. Low-dose naltrexone as a treatment for chronic fatigue syndrome[J]. BMJ Case Rep, 2020, 13(1): e232502. DOI: 10.1136/bcr-2019-232502.
    SCHMIDT M E, MILZER M, WEIβ C, et al. Cancer-related fatigue: benefits of information booklets to improve patients' knowledge and empowerment[J]. Support Care Cancer, 2022, 30(6): 4813-4821. doi: 10.1007/s00520-022-06833-w
    VAN WESTRIENEN P E, PISTERS M F, VEENHOF C, et al. Identification of patients with moderate medically unexplained physical symptoms in primary care with a five years follow-up[J]. BMC Fam Pract, 2019, 20(1): 66. http://www.xueshufan.com/publication/2946922936
    MCANDREW L M, FRIEDLANDER M L, ALISON PHILLIPS L, et al. Concordance of illness perceptions: the key to improving care of medically unexplained symptoms[J]. J Psychosom Res, 2018, 111: 140-142. http://www.xueshufan.com/publication/2803893476
    任菁菁. 全科常见未分化疾病诊疗手册[M]. 2版. 北京: 人民卫生出版社, 2020: 25-36.

    REN J J. The treatment of common medically unspecified disease in general practice[M]2nd edition. Beijing: People's Medical Publishing House, 2020: 25-36.
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