Covington, E C · Primary care · 1991
This study explores how chronic pain, fatigue, and depression often occur together in patients. The authors suggest that these three conditions share common causes and may influence each other. Treatment works best when doctors address each problem separately using a combination of physical rehabilitation, education, medications, and counseling.
This study is relevant to ME/CFS patients because it acknowledges that fatigue, pain, and mood disturbance frequently co-occur and may share underlying mechanisms. Understanding these interconnections may help clinicians and patients recognize that treating depression as a separate component could improve overall outcomes and provide hope for recovery.
This review does not establish causation—it does not prove that depression causes fatigue or pain, or vice versa. It does not present original empirical data or clinical trials demonstrating efficacy of the proposed management approach. The study also does not differentiate between depression as a primary condition versus depression secondary to living with chronic illness.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Covington, E C (1991). Depression and chronic fatigue in the patient with chronic pain.. Primary care. https://pubmed.ncbi.nlm.nih.gov/1876618/
BibTeX
@article{mecfsatlas-covington-1991-depression-chronic,
author = {Covington, E C},
title = {Depression and chronic fatigue in the patient with chronic pain.},
journal = {Primary care},
year = {1991},
note = {PubMed: 1876618},
url = {https://www.mecfsatlas.com/evidence/covington-1991-depression-chronic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/covington-1991-depression-chronic
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