Send to

Choose Destination
J Pain Symptom Manage. 2019 Dec 19. pii: S0885-3924(19)31063-2. doi: 10.1016/j.jpainsymman.2019.12.358. [Epub ahead of print]

A Qualitative Meta-Synthesis of the Experience of Fatigue across Five Chronic Conditions.

Author information

National Institute of Nursing Research, NIH, Bethesda, MD, USA. Electronic address:
School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.



Fatigue is a symptom reported by patients with a variety of chronic conditions. However, it is unclear whether fatigue is similar across conditions. Better understanding its nature could provide important clues regarding the mechanisms underlying fatigue and aid in developing more effective therapeutic interventions to decrease fatigue and improve quality of life.


To better understand the nature of fatigue, we performed a qualitative meta-synthesis exploring patients' experiences of fatigue across five chronic noninfectious conditions: heart failure (HF), multiple sclerosis (M_S), rheumatoid arthritis (RA), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD).


We identified 34 qualitative studies written in the last 10 years describing fatigue in patients with one of the above conditions using three databases (Embase, PubMed, CINAHL). Studies with patient quotes describing fatigue were synthesized, integrated, and interpreted.


Across conditions, patients consistently described fatigue as persistent overwhelming tiredness, severe lack of energy, and physical weakness that worsened over time. Four common themes emerged: Running out of Batteries, a Bad Life, Associated Symptoms (e.g. sleep-disturbance, impaired cognition, and depression), and Feeling Misunderstood by others, with a fear of not being believed or being perceived negatively.


In adults with HF, MS, RA, CKD, and COPD we found that fatigue was characterized by severe energy depletion which had negative impacts on patients' lives and caused associated symptoms that exacerbated fatigue. Yet, fatigue is commonly misunderstood and inadequately acknowledged.


chronic kidney disease; chronic obstructive pulmonary disease; fatigue; heart failure; multiple sclerosis; rheumatoid arthritis

Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center