How Fatigue Makes its Way Into Chronic Pain Conditions

Exhaustion-led issues are par for the course with chronic pain. But why?

Fibromyalgia, rheumatoid arthritisirritable bowel syndrome, complex regional pain syndrome (CRPS) and chronic tension headaches. These are just some of the many chronic pain conditions that heavily involve fatigue and exhaustion-like symptoms. Chances are, if you’re suffering from a chronic pain condition, you’ve felt the achy, draining nature of fatigue. Persistent fatigue can even be a sign of chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), a condition all its own. While many people may experience fatigue from time to time, chronic fatigue is defined as a consistent exhaustion or lack of energy that lasts at least 6 months, with a fatigue score of 8 or greater on the NIH Fatigue Scale (ask your doctor about how to determine your rating).

Chronic fatigue is so common in individuals with chronic pain, in fact, that it ranges from 10% to 40% of the general population, affecting up to an estimated 2.5 million people in the United States, and generating direct and indirect expenses of approximately $17 billion to $24 billion annually. Women are more likely to report fatigue and more often to report severe fatigue. For example, in one study, fatigue was shown in 30% of older women (aged 65 and older) compared with 15% of older men. In another, researchers discovered the frequency of fatigue as a symptom of endometriosis.

While chronic fatigue is most often linked to a serious illness or conditions (especially inflammatory diseases such as arthritis) or infection, many other factors can influence chronic fatigue. Neurological and hormone abnormalities (including neurological inflammation and low metabolism), impaired cognition (including auditory/visual challenges), and issues with the autonomic nervous system (heart rate, digestion, urination, etc.) have been found to be associated with CFS. For those with fibromyalgia, pain triggers associated with CFS may be familiar. Some of the symptoms that appear with chronic fatigue are described below, including ways to counteract them.

Sleep Disturbances

Sleep disturbances, leading to unnourished, unretentive sleep, is a leading factor in the instance of chronic fatigue. Sleep disturbances can include: insomnia, hypersomnia (oversleeping), sleep apnea (interrupted breathing during sleep), and restless legs syndrome. Individuals with chronic pain may find it especially difficult to get into a comfortable sleeping position or to stay asleep through the night when muscles or joints are sore or linger with pain. Tossing and turning in bed, or waking up repeatedly is a reality for many chronic pain warriors, leading to grogginess that carries throughout the day.

Read more about chronic pain and its impact on sleep at the National Sleep Foundation’s website.

Solution: The Reflex Sympathetic Dystrophy Syndrome Association (RSDSA), a nonprofit that provides support, education, and hope to all affected by the pain and disability of CRPS/RSD while also driving research to develop better treatments, offers many tips to getting a better sleep, improving on what is often called “sleep hygiene” techniques. Establishing a clear sleep routine is a great way to start better sleeping habits that will help get your body and your mind ready for bed.

  1. Use your bedroom only for sleep instead of for TV, reading, etc., and go to bed only when you’re sleepy.
  2. Start relaxing, calming activities before bed.
  3. Get out of bed if you cannot sleep, and do a quiet activity.
  4. Set your alarm to get up at the same time every morning.
  5. Avoid napping.
  6. Avoid alcohol, caffeine, and tobacco before bed.
  7. Don’t exercise right before bed.
  8. Adjust your bedroom to accommodate better sleep: hot/cold temperature, less light, no sound.

Physical Inactivity and Obesity

A lack of exercise and unused muscles due to living with a chronic pain condition can cause tiredness and exhaustion. Frequent inactivity may also lead to a loss of muscle mass, which is especially important to combat conditions such as severe arthritis. One study pointed out that people with fibromyalgia who spent more time doing light physical activity had lower levels of fatigue and pain than those who were inactive. Being overweight also increases the risk of developing sleep apnea and other sleep disturbances.

Poor Diet

Not getting adequate and healthy food and fluids in one’s diet can be a subtle, longer-forming cause of fatigue. Your body needs plenty of water and a substantial amount of vitamins and minerals to operate efficiently. Relying on junk food and an insufficient amount of water can cause one’s fatigue to be directly stemming from dehydration and vitamin deficiency.

Solution: Assess your dietary and physical needs. Do changes need to be made? Many lifestyle adjustments are important to counteract the frequency of fatigue. A doctor may suggest seeing a physical therapist or a nutritionist to reevaluate your needs in these areas. When combined with an exercise plan, patients will benefit from implementing a complementary treatment to go along with any medications taken.

Certain Medications

Several medications can cause drowsiness or fatigue, according to the Arthritis Foundation. Common medications known to have this effect include certain antidepressants; blood pressure medications; narcotic pain relievers; prescription nonsteroidal anti-inflammatory drugs; disease-modifying antirheumatic drugs, such as azathioprine and methotrexate; and antihistamines such as diphenhydramine (Benadryl). Corticosteroids may keep one awake at night as well, which can then cause fatigue during the day.

Solution: Talk to your doctor about the medications you are using. When you start taking a new medication, track its effectiveness over a period of time, or when side effects such as fatigue begin to creep up. Also, note when a medication that has previously worked begins to wear off. Communicating with your doctor on changes needed to your medication is crucial to keeping symptoms like chronic fatigue at bay.

Start Today

While these practices may not completely rid a chronic pain patient of fatigue, it is good to know the major culprits that lead to the accentuation of this common symptom. To date, there is not yet an FDA-approved treatment for CFS, and a proper diagnostic tool for clinicians has yet to be developed. Making the necessary changes to live a healthier life should be ideal for anyone managing fatigue when struggling with a chronic pain condition. Pain management is all about maintenance, and improving one’s life despite nagging symptoms is certainly a part of that. 

Updated on: 08/29/19
Continue Reading:
Living with Pain? Here’s Why Sleep is So Important and How CBT Can Help