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Causes Of Chronic Pain And Fatigue

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Biological Link Between Pain And Fatigue Discovered

Chronic Pain and Fatigue Research Center
University of Iowa
A recent study reveals a biological link between pain and fatigue and may help explain why more women than men are diagnosed with chronic pain and fatigue conditions like fibromyalgia and chronic fatigue syndrome.

A recent University of Iowa study reveals a biological link between pain and fatigue and may help explain why more women than men are diagnosed with chronic pain and fatigue conditions like fibromyalgia and chronic fatigue syndrome.

Working with mice, the researchers, led by Kathleen Sluka, Ph.D., professor in the Graduate Program in Physical Therapy and Rehabilitation Science in the UI Roy J. and Lucille A. Carver College of Medicine, found that a protein involved in muscle pain works in conjunction with the male hormone testosterone to protect against muscle fatigue.

Chronic pain and fatigue often occur together — as many as three in four people with chronic, widespread musculoskeletal pain report having fatigue and as many as 94 percent of people with chronic fatigue syndromes report muscle pain. Women make up the majority of patients with these conditions.

To probe the link between pain and fatigue, and the influence of sex, the UI team compared exercise-induced muscle fatigue in male and female mice with and without ASIC3 — an acid-activated ion channel protein that the team has shown to be involved in musculoskeletal pain.

Managing Chronic Pain And Fatigue

The key to reducing pain is reducing inflammation.

Thanksgiving 2019. Andrea Klockow of Alpharetta, Georgia, notices the middle finger on her right hand looks really âcreepyâ â like a sausage. Fortunately, it goes away, and Klockow doesnât give it much more thought.

Over the next four months, though, she starts struggling with overwhelming fatigue, sore fingers and pain in her ankles and knees. âMy joints, particularly the joints in my fingers, hurt the most,â 36-year-old Klockow recalls.

Summer 2020. Klockowâs scalp begins to itch so badly that it wakes her up from a deep sleep. âI couldnât see what was going on with my scalp, but I suspected something was up because I have always been a very sound sleeper,â she says. Klockow knows not to take all these symptoms lying down, so back to the rheumatologist she goes. This time, the rheumatologist suspects Klockow has psoriatic arthritis and suggests she see a dermatologist.

The dermatologist examines Klockow, looks at her scalp and puts her on a biologic, which works like a charm for her itching. âWithin 10 days of my first injection, I was starting to feel great,â Klockow says. The biologic doesnât help the joint pain as much right away, but her doctors tell her to be patient. With time, it will help her PsA as well, they say. They turn out to be right about that too. âNow I have all my energy back, and my joints donât hurt,â Klockow says happily.

How Does Chronic Fatigue Syndrome Affect Quality Of Life

People with CFS/ME often become exhausted after minor exertion. Basic daily activities may become extremely difficult. CFS/ME can make it difficult to go to school, to work, and to care for yourself or others.

According to the CDC, about 1 in 4 people with CFS/ME may need to stay in their bed or house.

One of the challenges of living with CFS/ME is that symptoms can fluctuate. You may feel more fatigue and pain on some days than others. It can be difficult to predict when you will feel worse and when you will feel better.

To help improve your quality of life:

  • Spread physically or mentally challenging tasks throughout the week or month.
  • Find ways to balance activity and rest.
  • Get enough sleep.
  • Divide big tasks into small, manageable steps.

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Rheumatoid Arthritis And Fatigue

Symptoms: Fatigue, morning stiffness, joint pain, inflamed joints

Rheumatoid arthritis , a type of inflammatory arthritis, is another cause of excessive fatigue. Because joint damage can result in disability, early and aggressive treatment is the best approach for rheumatoid arthritis.

Medications that may be used early in mild RA include:

  • Nonsteroidal anti-inflammatory drugs
  • Disease-modifying antirheumatic drugs

Other drugs used in more serious forms of RA include the anti-cytokine therapies , as well as shots and other forms of treatment.

Other autoimmune disorders, such as lupus and Sjogren’s disease, may also cause fatigue.

Tips To Deal With Fatigue Associated With Chronic Pain

The Many Faces of Chronic Fatigue Syndrome

Fatigue is a common symptom of many health conditions, including chronic pain. Fatigue isnt just feeling a bit sleepy or drowsy it presents as relentless exhaustion that doesnt improve with rest. Fatigue not only affects energy levels, it can also affect motivation.

Tips to help deal with fatigue include the following:

1. Treat the cause of fatigue

Consult a physician to determine if chronic pain is the actual cause of fatigue. Ensure an underlying health condition is not the culprit.

2. Double check pain medications

Talk with a pharmacist or physician about chronic pain medications to determine if they are contributing to fatigue.

3. Ask about medications to treat fatigue

A new class of drugs, called wakefulness-promoting agents, may be helpful in treating fatigue. Consult a physician to see if this new class of medication can help.

4. Rest when needed

Do not push to complete tasks within a certain time frame. Take breaks as needed to ensure pain levels do not increase, and the body receives the rest it needs.

5. Ask for help

Inform family and friends when help is needed with household chores, cooking meals or running errands.

6. Lose the guilt

Dont feel guilty about fatigue or chronic pain symptoms. Engage in the most activity possible, but also realize that rest and relaxation can also help ease symptoms.

7. Exercise regularly

8. Eat nutritious foods

9. Drink plenty of water

Consume eight glasses of water per day to stay hydrated.

10. Get into a sleep routine

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Psychostimulants And Modafinil As Adjuvants To Opioids

In the authors experience, psychostimulants and the wakefulness-promoting agent, modafinil , are underused in the management of chronic pain. The classic literature on chronic pain management generally makes reference to methyl-phenidate and dextroamphetamine as adjunctive drugs that improve opioid analgesia and reverse opioid-induced sedation. This literature was developed when chronic pain management with opioids mostly comprised cancer pain. One study showed that when dextroamphetamine 10 mg was added to morphine 6 mg for postoperative pain, the combination provided about the same amount of pain control as morphine 12 mg alone.21 Studies of methylphenidate have shown it to have significant analgesic effects in cancer pain.22 A more recent study showed that dextroamphetamine had preventive effects on chronic tension-type headaches and migraine headaches in some subjects.23

Tips To Alleviate Fatigue

  • Have your doctor review your medications. Many commonly prescribed medications can cause or exacerbate fatigue, like medications for pain, high blood pressure, sleep disorders, and depression. Talk to your doctor or pharmacist about your prescriptions, and ask if fatigue may be a side effect.
  • Get better sleep. Getting better sleep is one of the most significant ways to improve your fatigue and limit the pain it causes. Start by getting evaluated and/or treated for sleep apnea. Create a sleeping environment that promotes restful sleep, and stick to a strict sleep schedule. You can also try things like blackout curtains, eye masks, and weighted blankets.
  • Try to get light exercise. The University of Georgia published a study that found that low-intensity exercise decreases fatigue by 65 percent. In the study, participants engaged in 20 minutes of low-to-moderate exercise three days per week for six weeks and reported more energy. Try gentle exercises like walking, yoga, or water aerobics.
  • Cut out your vices. No one should be smoking, but people with diabetes should definitely refrain from cigarettes. Smoking worsens many conditions that can lead to pain, including neuropathy. Excessive alcohol use can also cause fatigue and should be refrained from as well.
  • The pain-fatigue cycle can be a difficult one to break, but addressing one problem may help you alleviate the other. Listen to your body and its limits, and talk to your doctor about managing your pain and fatigue.

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    Causes Of Fatigue In Arthritis

    Inflammation, pain, inactivity and lifestyle factors can cause extreme tiredness when living with arthritis.

    Everyone gets worn out from time to time. But exhaustion that disrupts your daily life and doesnt get better after a good nights sleep has its own medical term: fatigue. Fatigue significantly affects the quality of life for people with many forms of arthritis-related diseases, includingrheumatoid arthritis,psoriatic arthritis, spondyloarthritis, lupus, fibromyalgia andosteoarthritis. Your lack of energy may be caused by your inflammatory disease and other health conditions you have, as well asmedications side effectsand lifestyle habits.

    Is It Possible That I Have Pots And Was Incorrectly Diagnosed

    Stress, Fatigue, and Chronic Pain

    This is entirely possible. Given how common POTS symptoms are and how unfamiliar many doctors are with this condition, diagnostic mishaps happen. POTS is frequently misidentified as chronic fatigue syndrome, fibromyalgia, myofascial pain syndrome, anxiety disorder, ADHD, irritable bowel syndrome, myositis, etc. It is also possible that you have both POTS and one of these conditions, which may complicate the diagnosis. Sometimes people with POTS are told that its all in your head, implying that the cause of their symptoms is psychological. If you feel like something is physically wrong, dont hesitate to seek a second, and even a third or fourth opinion.

    COVID-19 and POTS: Is There a Link?

    Although many people recover quickly from COVID-19, the disease caused by the coronavirus, others who recover may continue to experience symptoms for months. Researchers are still determining the cause of these extended symptoms, but some COVID-19 “long-haulers” may actually be dealing with POTS.

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    Causes Of Chronic Fatigue Syndrome

    It can be very difficult to pinpoint the exact cause of a patients chronic fatigue syndrome because the symptoms can be triggered by a wide variety of factors.2,3,4,5 For example, some sufferers report that a viral infection seemed to lead to their chronic fatigue syndrome, which has led some researchers to believe that certain viruses may cause it.6 Immune system disorders may lead to chronic fatigue syndrome, as well as hormonal imbalances in the adrenal and pituitary glands.7Stress that is not controlled and managed can lead to a worsening of chronic fatigue symptoms too.

    Learn How To Get Through Your Day When Facing Pain And The Fatigue That Comes With It

    We dont need to tell you: Chronic pain can be exhausting. Facing an uncomfortable condition day in and day out takes its toll on your mind, body, and soul.

    Youre tired from experiencing the pain itself. Youre tired because youre not sleeping well. Youre tired from just trying to get through your daily schedule, something that can feel more like attempting to scale Mount Everest.

    While some conditions, such as , chiefly cause pain, and in turn, fatigue, other conditions, like chronic fatigue syndrome, are marked by exhaustion first and then pain.

    Meera Kirpekar, MD, Clinical Assistant Professor, Department of Anesthesiology, Perioperative Care, and Pain Medicine at the NYU Grossman School of Medicine, says that any pain condition can also present with fatigue, as pain and exhaustion often go hand-in-hand.

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    How Fatigue And Pain Are Related

    Many people who live with chronic fatigue also deal with chronic pain, and theres a reason for that. Continually fighting pain exhausts your body because pain makes it hard to rest completely. Pain can usually be a result of inflammation that takes a toll on your body or an untreated health problem. Often simply finding better ways to treat your illness and manage your pain can help to ease the fatigue you feel day after day.

    How Do People Live With Chronic Pain And Fatigue

    Pin on chronic fatigue,chronic pain,grief,Anxiety

    Having enough energy to move forward can be tough when youre dealing with chronic pain and fatigue. You likely spend most of your time just trying to get through your day, and without the energy left to do anything else, you may be frustrated as you try to plan for the future. Understanding how to cope with chronic pain and fatigue, though, can help you know what to do next.

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    Damage To The Cartilage At The Back Of The Kneecap

    Knee pain that feels worse when you go up or down stairs could be a sign of a damaged kneecap, called chondromalacia patellae.

    This should not cause any redness or heat around the knee.

    The cause is not understood, but it can be linked to overuse of the knee.

    You can treat this problem yourself with anti-inflammatory medicines, such as ibuprofen, an icepack and rest.

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    Inflammation: A Potential Link Between Fatigue Depression And Pain

    Although fatigue, stress or depression, and pain have complex and various mechanisms of action, some inflammatory cytokines are found associated with these three domains, so inflammation may be their potential link. The association between these symptoms has been documented in various medical conditions: classical inflammatory diseases such as rheumatic diseases, cancer or infections but also CFS, metabolic disorders or depression, which exhibit low-grade inflammation .

    Some authors found that in RA, fatigue, mood disorders and pain are clinically associated IL-1 level was higher in cerebrospinal fluid of patients than controls and the increased level was correlated with fatigue . Biologic treatments are efficacious and can decrease levels of markers of inflammation such as CRP tocilizumab is especially efficacious because of its action on IL-6 involved in the synthesis of CRP . Thus, decreased systemic inflammation could be one of the mechanisms of action improving fatigue, pain and mood disorders.

    Moreover, in a cohort of 1,466 European patients with advanced cancer, increased CRP level was associated with pain and fatigue . In ovarian cancer patients, diurnal and nocturnal cortisol and plasma IL-6 levels decreased during the first year following surgery, and this decrease was associated with decreased fatigue and depression .

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    Treating Pain And Fatigue With Psa

    Fatigue is another common symptom of PsA. âIn one study of 499 patients with PsA attending the University of Toronto PsA clinic, 49 percent had at least moderate fatigue, while severe fatigue occurred in 28.7 percent,â Dr. Gladman says.

    Fatigue is more common in women with PsA and in patients who have a higher degree of pain, Dr. Gladman says. About 22 percent of people with PsA also have fibromyalgia. âFibromyalgia is a condition which includes both chronic pain and fatigue,â she explains. Pain from fibromyalgia is not confined to the joints and is often described as âpain all over.â

    Like joint pain, the fatigue associated with PsA is due to inflammation, Dr. Gladman says. âFatigue will come and go with the inflammation. If fatigue is due to lack of sleep, it will improve when you get enough sleep. If fatigue is due to fibromyalgia, it may persist unless the fibromyalgia is managed appropriately,â she says. Treating fibromyalgia involves a program of medication, exercise and relaxation, she adds.

    According to the joint American College of Rheumatology and NPF guidelines for treating PsA, âIt is recommended that patients with active PsA use some form or combination of exercise, physical therapy, occupational therapy, massage therapy, and acupuncture over not using these modalities as tolerated.â

    Diagnosing and treating PsA early can help prevent or at least limit the joint damage that can occur in later stages of the disease, Dr. Gladman says.

    Tiredness And Chronic Pain Management

    Centralized Pain: Chronic Pain and Fatigue Research Center

    Doctor, I feel tired a lot. Is this person sleepy, fatigued, depressed, apathetic, or suffering the secondary effects of pain? Certain disorders that generate a daytime condition of drowsiness or fatigue include, but are not limited to:

    • Lowered arousal and level of consciousness
    • Fatigue due to a reduced energy state
    • Depressed mood and anhedonia
    • Apathy and lack of motivation
    • Sleep apnea
    • Non-restorative or poor quality of sleep

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    How Can I Care For Myself With Chronic Fatigue Syndrome

    In addition to the treatments above, there are things you can do to help manage this condition, such as:

    • reducing your stress
    • getting plenty of rest
    • making sleep a priority if you are having trouble sleeping, check out these tips to improve your sleeping habits
    • eating a healthy diet to make sure your body is getting the nutrients it needs
    • having plenty of salt if you have low blood pressure and a tendency to feel dizzy or even faint on standing
    • learning to prioritise the things you need to get done, and then pacing yourself by dividing them into short times of activity with rest breaks in between
    • learning mindfulness, meditation or creative visualisation
    • getting out into nature regularly, listening to music and enjoying your pets
    • developing a support network of understanding friends and family/whnau for when you need help
    • joining a support group if there is one in your area
    • talking to your doctor about whether there are any medications or supplements that may help you.

    Keep A Blanket And Pillow In Your Office

    Rheumatoid arthritis and fatigue go hand in hand for me, says Marco S., 37, of Mission Viejo, California. When its at its worst all I want to do is sleep but, you know, I have a job. His solution? I keep a small pillow and blanket under my desk so if I have some downtime I can shut my door and take a nap.

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    What Questions Should I Ask My Doctor

    • Take along a list of all the symptoms you are experiencing in case you forget some of them during your talk with the doctor or nurse.
    • Talk about how much you can do at work or school and around the house.
    • Ask if there are any financial supports or services you could apply for.
    • Ask for help with pain, sleep and remaining active if these are problems for you.
    • Ask about what you should be eating.

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