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Cleveland Clinic Chronic Fatigue Syndrome

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Q: What Are The Symptoms Of Pots

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A: The most common symptom of POTS is chronic fatigue. Other symptoms include body aches and exhaustion. About a third of patients faint. Other patients are plagued by adrenaline symptoms such as chest pain, racing heart rate , sweating and difficulty breathing. POTS feels like having the flu, but having to drink coffee to get through the day.

How Common Is Chronic Myofascial Pain

Pain originating in the muscles and fascia is very common. Nearly everyone at some point suffers from this type of pain, known as myalgia fasciitis or myofascitis. CMP, however, involves pain that is chronic, or long lasting, and is associated with specific trigger points.CMP most often occurs in people between the ages of 30 and 60 years. It affects men and women equally.

How Is Myalgic Encephalomyelitis/chronic Fatigue Syndrome Diagnosed

Your doctor diagnoses ME/CFS by performing a mental and physical examination. Doctors will ask about your medical history and order blood and urine tests to check for infection. In many cases, doctors refer people with suspected ME/CFS to other specialists to rule out other illnesses that could be causing symptoms.

For your doctor to diagnose ME/CFS, you must have these 3 symptoms:

  • Severe fatigue lasting at least 6 months that does not improve with rest or sleep
  • Difficulty sleeping
  • Fatigue that gets worse after mental or physical exercise

Additionally, you must have at least 1 of the following symptoms:

  • Orthostatic intolerance

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How Is Myalgic Encephalomyelitis/chronic Fatigue Syndrome Treated

There is no cure for ME/CFS. Treatment goals include managing symptoms and returning you to a higher quality of life. Some people arenât able to regain the level of health and function they had before their diagnosis.

First, your doctor works with you to determine which symptoms cause the most difficulty. Together, you will address those symptoms immediately.

Counseling is helpful for many people with ME/CFS. This type of treatment helps people better tolerate symptoms by changing thoughts and behaviors. Your doctor may prescribe medications, like antidepressants or sleep aids, if your symptoms are especially severe. These medications can relieve symptoms like unrestful sleep for some people living with ME/CFS.

Before prescribing sleep aids, however, your doctor may provide suggestions for improving sleep without drugs. For instance, he or she might suggest that you visit a sleep specialist. Other tips include:

  • Develop a regular bedtime routineâgo to bed and wake up at the same time each day.
  • Do not nap for more than 30 minutes total during the day.
  • Use your bed and bedroom only for sleeping and sex. Take out all electronics.
  • Avoid eating large meals before you go to bed also avoid alcohol and caffeine.
  • Do your exercising at least 4 hours before you go to sleep.

Central Nervous System Abnormalities

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Abnormal levels of certain chemicals in the brain system known as the hypothalamus-pituitary-adrenal axis have been proposed as a cause of CFS. This system controls important functions, including sleep, the stress response, and depression. Some people with CFS appear to have imbalances in hormones controlled by the HPA axis, such as cortisol.

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Q: What Is Adrenal Insufficiency

A: Adrenal insufficiency is a state in which your adrenal glands dont function properly and cannot secrete the vital hormones your body needs to function normally.

Adrenal insufficiency can be caused by Addisons disease, a pituitary disorder or another disorder. Some symptoms of this life-threatening dysfunction include extreme exhaustion, lack of appetite , diarrhea, nausea, low blood pressure and low blood sugar.

How Is Cancer Fatigue Managed Or Treated

The first step in treating fatigue is knowing the problem exists. Many people don’t bother to mention fatigue to their doctors because they believe it is normal. It’s vital that you discuss this and all symptoms or side effects with your healthcare provider. Then, efforts can be directed at determining the cause of the problem and prescribing appropriate treatment. Your particular cancer treatment regimen, with its known side effects, may provide clues for your doctor or health care professional. A simple blood test, for example, can determine if you are anemic.

There is no single medication available to treat fatigue. However, there are medications available that can treat some of the underlying causes.

When youre struggling, you may want to see a palliative care specialist. These experts help people with cancer manage symptoms like pain, nausea and depression.

Your provider or palliative care team may recommend these actions to ease fatigue:

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What Should I Expect When I Come To The Clinic

You will first be seen by a doctor who will make a detailed clinical assessment. Your doctor may do some blood tests to exclude other possible causes of fatigue and associated symptoms, and review any medicines you are currently taking.

Other members of the team will also help you manage your condition. They will plan a personal programme for you. This may be one to one or you could be part of a small group. The plan may include:

  • Occupational Therapy
  • Cognitive Behavioural Therapy
  • Dietary Advice
  • Acupuncture

The doctor may see you for follow-up appointments during the programme to review any change in medication, and for final review once treatment is completed.

How Ischronic Myofascial Pain Treated

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Treatment options might include:

  • Physical therapy: A therapy program includes stretching, postural and strengthening exercises.
  • Medicine: Non-steroidal anti-inflammatory drugs , such as ibuprofen and naproxen, might be used to help reduce pain.
  • Massage therapy: Therapeutic massage can loosen tight muscles and relieve cramping or spasms.
  • Workplace ergonomics: You can adapt your workspace to minimize strain .
  • Injections: This involves injecting a pain medicine directly into the trigger points.

It is also important to address any factors such as poor posture or mechanical problems that might be contributing to CMP pain.

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A Help For Both Conditions: Get Better Rest

Good sleep hygiene is important whether youre dealing with fatigue or narcolepsy.

Here are some tips:

  • Allow adequate time for sleep at night and keep consistent bed/wake times.
  • Keep your bedroom comfortable, cool, dark and quiet.
  • Arrange for a wind-down period of time before bed to calm your mind and body.
  • For best results, remove electronics from your bedroom and avoid all screens for one hour before you go to sleep. TVs, phones, tablets and computers all can disrupt your sleep.
  • Daily exercise can also improve sleep quality at night.

If you feel tired all the time or have trouble staying awake in meetings or at other times during the day, talk to your healthcare provider. They can help you pinpoint the cause and find a way to treat it.

Professional Education And Training

The RLHIM is also a teaching hospital and from time to time other healthcare professionals may observe in outpatient clinics as part of a training course. We will always ask your permission for students to sit in during your consultation. You do not have to have students present if you would prefer not to.

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How Long Does Cancer Fatigue Last

Everyones experience with cancer fatigue is unique. For some people, fatigue lasts a few weeks. Others may feel exhausted for years. You may feel better when your cancer treatments stop, but often fatigue lingers.

  • Bone marrow transplants can cause prolonged fatigue that lasts up to a year.
  • Radiation therapy fatigue often gets worse as treatments progress. Fatigue should lessen a few months after you stop treatment.
  • Surgery tends to cause temporary fatigue that goes away after you recover.
  • Systemic treatments can cause fatigue that comes and goes. These treatments include chemotherapy, immunotherapy and targeted therapy. You may be exhausted while taking the medications and feel better during the recovery phase . When treatment resumes, you feel exhausted again. You should have more energy when you finish the treatment.

How Is Fibromyalgia Diagnosed


There isnt a test that definitively diagnoses fibromyalgia. The diagnosis of fibromyalgia is clinical based on your symptoms and physical exam. Basic blood tests are recommended to exclude other causes of fatigue such as anemia or thyroid disease. The diagnosis relies on your family and medical history combined with your symptoms.

People with fibromyalgia tend to be deeply sensitive to pain that wouldnt bother most people. Your provider may assess the number of tender points, or areas, on your body that are highly sensitive to touch. For a diagnosis, widespread pain should be present for three months along with fatigue and other symptoms such as memory and concentration difficulties, poor sleep, symptoms of depression and irritability syndrome.

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What Are The Symptoms Of Chronic Myofascial Pain

The most notable feature of CMP is the presence of trigger points. These trigger points or tender points are highly sensitive areas within the muscle that are painful to touch and cause pain that can be felt in another area of the body, called referred pain.

Trigger points might be active or latent. An active trigger point is always sore and can prevent the full use of the muscle, subsequently leading to weakness and decreased range of motion. A latent trigger point does not cause pain during normal activities, but is tender when touched and can be activated when the muscle is strained, fatigued or injured.

Other symptoms associated with CMP include a sensation of muscle weakness, tingling and stiffness. The pain associated with CMP might also lead to problems sleeping.

Chronic Fatigue Syndrome Is A Very Misunderstood Disorder That Causes Individuals Excessive Fatigue

According to the Centers for Disease Control and Prevention , approximately 4 million people suffer from chronic fatigue symptoms and about 85% of U.S. citizens with CFS remain undiagnosed.

In addition to causing fatigue, the disorder can impair memory, decrease mental concentration and cause muscle pain, insomnia, headaches, and allergies. All of these things added together can negatively affect a persons normal activities and leave them feeling exhausted and disengaged.

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How Ischronic Myofascial Pain Diagnosed

Your healthcare provider usually begins with a thorough physical examination and medical history, including a review of symptoms. The provider will likely perform a detailed exam of the affected muscles, including strength and range of motion testing. He or she will rub the suspected trigger points to see if the muscles respond, or twitch, and cause pain in a predictable pattern or specific region.

Sometimes blood tests will be performed to look for medical causes of muscle pain, such as vitamin D deficiency or hypothyroidism.

Who Is At Risk For Chronic Fatigue Syndrome

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Because the cause of CFS is not known, its hard to know what might put someone at risk for getting the condition. But certain factors are seen more often in people with CFS. These factors include:

  • Gender. CFS happens up to 2 to 4 times more often in women than in men.
  • Age. CFS often affects middle-aged people. But people of any age can get it.

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How Is Chronic Fatigue Syndrome Diagnosed

A CFS diagnosis must rule out other possible conditions. According to the Institute of Medicine, a CFS diagnosis requires all 3 of these symptoms:

  • Having to cut back greatly on activities you did before the illness. Severe and chronic tiredness must have lasted for more than 6 months, and other health conditions have been ruled out. Rest does not ease these symptoms.
  • Severe tiredness after physical activity. The fatigue gets worsen after physical or mental stress that you could handle before the illness started.
  • Sleep that doesn’t refresh you.

In addition, you must have 1 of these symptoms:

  • Trouble thinking that gets worse under pressure.
  • Orthostatic intolerance. This means standing upright makes symptoms worse. Lying back down or raising your feet may ease the symptoms. But it doesn’t fully get rid of them.

How Are These Conditions Treated

For fatigue: Since it is likely a sign of another problem, your healthcare provider will focus on finding and treating that.

If a primary cause is not found, your healthcare provider may recommend:

  • Cognitive behavioral therapy. It challenges beliefs and awareness of your fatigue, helping you control symptoms and change behavior that may make your condition worse.
  • Graded exercise therapy. It helps with underlying deconditioning, starting with low-intensity activity like walking or stretching and building from there.

For narcolepsy: Your healthcare provider likely will recommend a sleep study, encourage changes in behavior, such as strategic napping and caffeine intake. However, you may need prescription medications to help stay awake during the day or improve sleep quality at night.

Its important to have a good psychosocial support system. Talking to your family about your condition or working with a counselor or a support group can help a lot.

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What Causes Fibromyalgia

Medical experts dont know why some people develop fibromyalgia. It sometimes runs in families. Certain conditions or events may bring on symptoms, such as:

  • Stressors such as: being born premature, traumatic life events such as abuse, accidents.
  • Medical conditions such as viral infections or other illnesses.
  • Anxiety, depression, other mood disorders, PTSD.
  • Poor sleep.
  • Lack of exercise.

How Your Family Can Help

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Always remember that youre not alone. Support from your family can make your condition easier to bear by spending time with you on good days as well as the bad days.

I try to make family members a partner in treatment, he says. When you just want to spend the day in bed watching TV because of fatigue or pain, a family member can encourage simple, fun activities to help get you moving.

Whether your diagnosis is chronic fatigue or fibromyalgia, a doctors role in treating the disease small. A doctor is there as the coach and can help you with the first 10% to 15% of improvement, while you have to help yourself manage the remaining 85% to 90%.

If youre suffering with chronic pain and/or fatigue, talk to your doctor. A diagnosis can put you in a better position to manage your symptoms even if there are still some mysteries surrounding your disease.

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What Are Chronic Fatigue Syndrome And Fibromyalgia

They are chronic conditions which affect daily functioning and involve chronic fatigue not much relieved by rest and made worse by exertion, chronic widespread muscle pain , sleep disturbance , concentration difficulties, and sometimes mood disturbance, headaches, intestinal, urinary and a range of other possible symptoms.

How Can I Combat Cancer Fatigue

The best way to combat fatigue is to treat the underlying cause. Unfortunately, the exact cause may be unknown, or there may be multiple causes. There are treatments to reduce certain causes of cancer fatigue, such as anemia or hypothyroidism. Other causes must be managed on an individual basis.

The following are tips you can use to combat cancer fatigue:

  • Conserve energy.
  • Manage your stress.

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What Do We Know About Fibromyalgia

Of the two, fibromyalgia affects about 4 million Americans and is one of the most misunderstood conditions. Many times, family members and friends dont understand what having fibromyalgia means and what it means to suffer from it.

Many patients get their diagnosis between the ages of 20 and 50, but the incidence increases with age. By age 80, about 8% of adults have fibromyalgia. according to the National Fibromyalgia Association. About 75% to 90% of those who have fibromyalgia are women.

The cause of fibromyalgia is unknown, says Dr. Bolash. Genetics, trauma or an infection may play a role. Fibromyalgia sufferers say it feels like having the flu all the time.

Symptoms include:

  • Fatigue and tiredness.

What Questions Should I Ask My Doctor

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If you have fibromyalgia, you may want to ask your healthcare provider:

  • Why did I get fibromyalgia?
  • Am I at risk for other conditions?
  • What is the best treatment for me?
  • What lifestyle changes can I make to manage symptoms?
  • Are other family members at risk for fibromyalgia? How can they lower this risk?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Fibromyalgia symptoms chronic fatigue and all-over body pain can take a toll on your mental and physical well-being. Self-care, such as exercise, a healthy diet, improved sleep and stress relief, can help you enjoy a better quality of life. Talk to your healthcare provider about the best ways to make these changes. Your provider can also recommend medications to manage symptoms.

Last reviewed by a Cleveland Clinic medical professional on 11/01/2020.


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How Can Exercise Help Reduce Cancer Fatigue

You may feel ill from your cancer or treatment, which may lead to less physical activity. Decreased levels of physical activity can lead to tiredness and lack of energy. Scientists have found that even healthy athletes forced to spend extended periods in bed or sitting in chairs develop feelings of anxiety, depression, weakness, fatigue and nausea. Regular, moderate exercise can decrease the feeling of fatigue and help you feel energetic. Even during cancer therapy, it’s often possible to continue to exercise. Be sure to check with your healthcare provider before starting an exercise program.

Exercise has many health benefits. Regular exercise can:

  • Increase your appetite.

Can Sleep Be Improved To Reduce Cancer Fatigue

Sleep is an important part of wellness. Good sleep can improve your mental and physical health. Several factors contribute to how well you sleep, and there are things you can do to improve your sleep, including:

  • Doing relaxation exercises, meditation or relaxation yoga before going to sleep.
  • Avoiding long afternoon naps.
  • Going to bed only when sleepy. Use your bedroom only for sleep and sexual activities.
  • Setting a consistent time to lie down and get up.
  • Avoiding caffeine and stimulating activities in the evening.
  • Establishing a relaxing pre-sleep routine.

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