Awareness and Perception of Myalgic Encephalomyelitis and Chronic Fatigue Syndrome Among Pain Specialists: A Questionnaire-Based Study

TL;DR

This study surveys pain specialists in Turkey to understand their awareness and treatment approaches for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), revealing gaps in knowledge and diagnostic practices.

Contribution

This is the first questionnaire-based study assessing pain physicians' awareness and attitudes toward ME/CFS in Turkey.

Findings

Only 39.6% of participants had previously heard of myalgic encephalomyelitis.

50.9% of physicians agreed that chronic fatigue decreases with intense aerobic exercise, a controversial view.

Most participants (65.9%) rarely considered the relationship between fatigue and orthostatic intolerance.

Abstract

Background: This study aims to explore the perceptions and clinical approaches of pain management specialists toward myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a condition characterized by persistent fatigue, widespread pain, unrefreshing sleep, and autonomic dysfunction. Given the challenges in diagnosis and management, pain specialists may play a pivotal role in symptom relief. By identifying variations in evaluation and treatment practices, this study seeks to enhance the recognition of ME/CFS and improve its clinical management within pain medicine.

Material and methods: The questionnaire was distributed in printed form to 250 pain specialists in Turkey. Given the limited number of pain physicians in the country, the study aimed to encompass all actively practicing specialists. The survey included four demographic questions, eight true-false questions, 12 multiple-choice questions, and four rating-scale questions. Data were collected anonymously. Data were analyzed using Statistical Product and Service Solutions (SPSS, version 27.0; IBM SPSS Statistics for Windows, Armonk, NY), with descriptive statistics and chi-square (χ²) tests applied to examine the relationships between awareness levels and attitudinal variables.

Results: In Turkey, 106 pain medicine physicians (42.4%) participated in the study. The average age was 40.6±8.52 years. Among the participants, 39.6% had previously heard of myalgic encephalomyelitis. Physicians were inclined to first ask the question, "Do you think you get enough sleep at night?" when evaluating these patients, with a rate of 63.2%. The majority of participants (65.9%) stated that they "occasionally" or "rarely" considered the relationship between fatigue and orthostatic intolerance. Additionally, 37.7% believed that this disease is a subtype of depression. The statement, "chronic fatigue decreases with intense aerobic exercise," was agreed upon by 50.9% of participants. This controversial statement was particularly more common among those who were unaware of ME/CFS's alternative name (p=0.009) and those who did not take dysautonomic disorders into account (p=0.048). When considering an ME/CFS diagnosis, physicians most frequently referred patients to the physical medicine and rehabilitation department (32.1%). Those who preferred not to refer patients to any department (12.3%) tended to find it appropriate for a patient to seek consultation at a pain medicine clinic due to widespread body pain and fatigue (χ2=11.405, p=0.044).

Conclusion: This study is the first questionnaire-based research assessing pain physicians' awareness and attitudes toward ME/CFS. By highlighting their perspectives on its evaluation and management, our findings may improve recognition and clinical approaches to ME/CFS. Future research should focus on education and standardized guidelines to enhance patient care.

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