Multidimensional Fatigue and Its Relationship With Pain and Activity Patterns in Individuals With Chronic Spinal Pain

Eur J Pain. 2026 Sep;30(8):e70399. doi: 10.1002/ejp.70399.

ABSTRACT

BACKGROUND: Fatigue frequently co-occurs with chronic pain, yet how its individual dimensions relate to pain characteristics in chronic spinal pain remains unclear. We investigated the relationships between pain severity, pain duration and multidimensional fatigue and compared fatigue and quality of life across activity pattern subgroups.

METHODS: This cross-sectional study included 109 individuals (mean age 38.23 ± 13.19 years) with chronic spinal pain. Pain severity was assessed with the Numerical Rating Scale (NRS), fatigue with the Multidimensional Fatigue Inventory (MFI-20), activity patterns with the Patterns of Activity Measure-Pain (POAM-P) and quality of life with the World Health Organization Quality of Life Scale Short Form (WHOQOL-BREF).

RESULTS: All significant correlations were in the very weak to weak range (rho ≤ 0.41). General and physical fatigue, reduced motivation and MFI-20 total scores correlated weakly with pain parameters (p < 0.05). Mental fatigue correlated with resting (rho = 0.271) and night pain (rho = 0.220) but not with activity pain or pain duration; reduced activity showed a comparable pattern. The general health domain correlated negatively with pain severity and duration (p < 0.05). Participants were categorized as avoidance (n = 40), overdoing (n = 51), or pacing (n = 18). The avoidance group showed higher reduced activity scores; this difference remained significant in Bonferroni-corrected pairwise comparisons (p = 0.001) but, as the only significant finding among fifteen subgroup comparisons, warrants cautious interpretation.

CONCLUSIONS: Multiple dimensions of fatigue show weak associations with chronic spinal pain. Mental fatigue and reduced activity correlated with rest and night pain but not activity pain, a pattern not specific to the cognitive dimension. Incorporating pattern-specific approaches into clinical management may prove beneficial.

SIGNIFICANCE STATEMENT: This study examined multiple dimensions of fatigue in chronic spinal pain within the framework of the avoidance-endurance model. Mental fatigue and reduced activity showed comparable weak associations with resting and night pain, but not with activity pain, indicating that this pattern is not specific to the cognitive dimension. Differences between activity pattern subgroups were limited. The findings support assessing fatigue multidimensionally and highlight the need for larger studies examining fatigue across activity-related subgroups.

PMID:42766485 | DOI:10.1002/ejp.70399