P-024 YI Fatigue Is Associated with Increased Pain Intensity and Interference in IBD

Abstract

Background: Fatigue is a frequently reported symptom in chronic medical disorders. In IBD, chronic fatigue has been found to be 2 to 3 times more common than in healthy controls as well as to affect up to 40% of patients in remission. In addition to fatigue, pain is also frequently reported in IBD patients. The latter refers to abdominal pain per se, but also to extra-intestinal pain-particularly affecting the joints. The relationship between fatigue and pain in IBD remains unexplored and the aim of this study was consequently to investigate potential associations between these 2 symptoms. Method(s): Patients were recruited from 9 hospitals in the southeastern and western part of Norway as a part of an observational, multicenter study. Clinical and epidemiological data was gathered by interview, medical records and laboratory tests. Pain was measured with the brief pain inventory (BPI) containing a pain intensity section 4 items scored from 0 (no pain) to 10 (worst possible pain), and a functional interference section 7 items that are scored from 0 (no interference) to 10 (complete interference). A pain severity score is calculated from the mean of the 4 pain intensity items and a pain interference score is calculated from the mean of the 7 pain interference items. Fatigue was measured with the fatigue questionnaire (FQ) consisting of 11 items divided into: Physical Fatigue (PF; 7 items) and Mental Fatigue (MF; 4 items). Responses were based on 4 options (0-1-2-3). Higher scores imply higher levels of fatigue. The scale scores of the FQ are also scored on a dichotomized scale (0 = better than usual and no more than usual, 1 = worse than usual, and much worse than usual). Substantial fatigue was defined as a dichotomized score >4, while chronic fatigue (CF) was defined as a dichotomized score >4 and, in addition, a duration >=6 months. Result(s): A total of 452 patients were eligible and asked to participate. Four hundred and fourteen patients (91.6%) gave written informed consent. Six out of 414 patients were excluded due to missing data, leaving the number included for analyses at 408. Of these, 228 were diagnosed with CD and 180 with UC. Among UC patients, substantial (SF) and chronic fatigue (CF) was present in 50.6 and 25.6%, respectively. The corresponding figure in Crohn's disease was 45.2 and 21.9%. Substantial fatigue was associated with significantly increased pain intensity and interference (all P's < 0.001) regardless of diagnosis. In CD, chronic fatigue was associated with increased pain intensity at the P < 0.05 level. Pain interference in CD as well as intensity and interference in UC were all associated with chronic fatigue at P < 0.001. Conclusion(s): Substantial and chronic fatigue was significantly associated with increased pain intensity and interference regardless of IBD diagnosis. These findings may be important to consider in daily clinical follow-up in IBD in order to alleviate the patients' symptom burden. Moreover they may be useful in planning future intervention studies.