Fatigue Plus Pain – Le double pépin de la fibromyalgie et que faire?

Plusieurs facteurs peuvent jouer dans le mélange qui draine de l’énergie dans la fibromyalgie, explique le Dr Pellegrino, mais de nombreuses stratégies permettent également de minimiser leur impact sur la vie quotidienne.

Dans les groupes de soutien du SCF et les groupes de soutien de la fibromyalgie auxquels j’ai assisté, la discussion et la douleur sont des sujets de discussion fréquents… Je pense qu’une personne décrivant sa fatigue l’a mieux dit. Elle a dit que ses paupières ressemblaient à des poids en ciment et qu’elle portait des chaussures en ciment. La fatigue peut être un problème accablant dans la fibromyalgie et, malheureusement, de nombreuses personnes sont victimes du double sort – une douleur intense et une fatigue intense.

Pourquoi les patients atteints de fibromyalgie (et de SFC) ont-ils un tel problème de fatigue?

Il y a plusieurs facteurs impliqués. Ces facteurs incluent:

1.  Trouble du sommeil non réparateur La
restauration qui devrait avoir lieu au cours de la phase profonde du sommeil ne se produit pas. La fabrication des protéines, la reconstitution des réserves d’énergie et la réparation des tissus sont incomplètes. Un mauvais sommeil entraîne une fatigue accrue.

2.  Muscles
déconditionnés Dans la fibromyalgie, les muscles déconditionnés ont perdu leur capacité à fabriquer des molécules d’énergie appelées ATP (adénosine triphosphate). Cette molécule d’énergie est stockée dans nos tissus, en particulier nos muscles, et est utilisée comme carburant pour permettre à l’organisme de remplir toutes ses fonctions, y compris les contractions musculaires.

La fatigue se produit moins il y a d’ATP, moins il y a d’énergie disponible, et une fois que les réserves stockées sont épuisées. Si ce processus se produit rapidement, on peut ressentir un choc énergétique soudain et imprévisible. Dans la fibromyalgie, notre ATP chroniquement bas contribue à la fatigue chronique.

3.  Douleur constante
Le processus de surveillance de la douleur par le corps, l’enregistrement de la douleur et l’expression de la douleur consomment de l’énergie et impliquent des nerfs, des neurotransmetteurs et d’autres enzymes et hormones. Le patient en douleur constante consommera plus d’énergie et aura moins d’énergie stockée que la normale. (Voir «Fibromyalgie – finalement une maladie de la douleur amplifiée».)

4.  Diminution de l’utilisation d’oxygène par les muscles
Des études ont montré que les muscles atteints de fibromyalgie n’utilisaient pas l’oxygène aussi bien que les muscles normaux. Cela peut refléter un problème avec les mitochondries musculaires, les petites organites qui utilisent de l’oxygène et fabriquent de l’ATP. Un problème biochimique peut empêcher l’utilisation efficace et adéquate de l’oxygène disponible pour créer de l’ATP.

5.  Dépression clinique associée La dépression
est observée chez près de la moitié des patients atteints de fibromyalgie et peut provoquer une fatigue mentale extrême.

6.  Affections chroniques associées
telles que l’arthrite, l’hypothyroïdie ou une autre maladie. Les personnes atteintes de fibromyalgie peuvent avoir d’autres affections qui consomment beaucoup d’énergie et contribuent à une fatigue excessive.

7.  Facteurs cognitifs
La fibromyalgie provoque des difficultés de concentration et d’attention, une anxiété accrue, une sensibilité accrue à la dépression et une absence de conscience. Ceci est notre fibrofog. (Voir «Gestion de fibrofog – Le dysfonctionnement cognitif de la fibromyalgie».)

8.  Système nerveux autonome dysfonctionnel
Nous sommes plus enclins à l’anxiété et aux attaques de panique, au phénomène de Raynaud, à la fréquence cardiaque rapide (surtout en réponse au stress), aux éruptions cutanées (en particulier au toucher), à la gorge, au syndrome du côlon irritable, irritable la vessie et d’autres symptômes qui résultent tous d’un système nerveux autonome trop sensibilisé. La fatigue peut également être une conséquence de nos nerfs autonomes dysfonctionnels. (Le système nerveux autonome maintient les fonctions corporelles «automatiques» exercées par de nombreux organes, muscles et glandes et entraîne des réactions au stress physique ou émotionnel – combat ou fuite. Voir «Ceux qui fonctionnent en autonomie dysfonctionnelle».)

9.  Surcharge visuelle
J’utilise ce terme pour décrire les informations accablantes que nos yeux reçoivent et qui ont du mal à interpréter. (Révisé au chapitre 4 de  La fibromyalgie: de près et personnel .)

Nous essayons de repérer un objet en particulier, mais sommes confrontés à une variété de formes, de tailles, de couleurs et de lignes dans différentes directions qui submergent littéralement nos sens visuels et provoquent parfois une sensation de vertige, d’étourdissement et d’anxiété accrue. Je pense que cela contribue à la fatigue en demandant beaucoup d’énergie pour trier cette information.

10.  Diminution de l’endurance respiratoire
De nombreux patients atteints de fibromyalgie se plaignent de leur essoufflement et de brèves activités, telles que grimper sur des marches, courir ou marcher rapidement. Ils peuvent en fait avoir du mal à reprendre leur souffle. Cette affection respiratoire peut être due à une fatigue soudaine des muscles respiratoires, induite par un exercice, qui perturbe le rythme respiratoire.

La plainte semble être indépendante de la question de savoir si la personne est en mauvais état ou mène une vie sédentaire. Puisqu’un processus respiratoire efficace est nécessaire pour apporter de l’oxygène à la circulation sanguine, tout problème dans cette zone créera certainement un risque de fatigue.

11.  Mouvements musculaires constants Les
personnes atteintes de fibromyalgie modifient fréquemment leur corps pour trouver des positions plus confortables. Les mouvements habituels tels que tapoter des doigts sur la table, tapoter ou faire rebondir les pieds sur le sol, croiser fréquemment les jambes et expulser une jambe sont probablement des mouvements inconscients pour soulager le stress musculaire, maintenir le sang couler et réajuster les muscles et la posture essayer de diminuer la douleur. Cependant, l’effet secondaire de ces mouvements est une consommation d’énergie accrue.

12.  Problèmes hormonaux Une
diminution de l’approvisionnement en hormones ou une utilisation inefficace des hormones disponibles peut contribuer à la fatigue. Les taux faibles d’hormone de croissance et de thyroïde sont fréquents dans la fibromyalgie et peuvent réduire le métabolisme énergétique et donc augmenter la fatigue. Les mécanismes de stress modifiés dans notre corps augmenteront la consommation d’énergie et entraveront l’utilisation efficace de l’énergie, ce qui aggravera la fatigue. L’estrogène et la sérotonine sont d’autres hormones qui peuvent causer de la fatigue en cas de pénurie.

13.  Hypoglycémie / hypersensibilité à l’insuline
Notre cerveau nécessite une dose constante de glucose (sucre dans le sang) et si nos dysfonctionnements nutritionnels conduisent à une hypoglycémie, notre cerveau réagira en signalant: «Vous vous sentirez mal jusqu’à ce que je prenne plus de glucose!» (Voir discussion de l’hypoglycémie dans “Pourquoi la prise de poids est un problème de fibro, et que faire à ce sujet.”)

14.  Faible teneur en magnésium
Les concentrations de magnésium dans les cellules sont faibles chez la plupart des patients atteints de fibromyalgie. Le magnésium est un minéral clé dans la formation de molécules d’ATP / énergie dans les muscles. Une faible teneur en magnésium signifie une faible teneur en ATP, ce qui signifie davantage de fatigue. (Voir «Approches nutritionnelles dans la fibromyalgie: carences, symptômes, stratégies de supplément».)

15.  Candidose (infection à levures)
En règle générale,  Candida albicans  vit dans le tractus intestinal de 80% de la population humaine sans aucun effet nocif. Dans la fibromyalgie, le  candida  peut proliférer dans les intestins et devenir «hostile». Cela peut entraîner des symptômes systémiques, notamment de la fatigue. (Voir «Candidose – Infection de levure et réparation nutritionnelle».)

La fatigue crée des problèmes dans nos activités quotidiennes, peu importe la ou les causes. Un effet négatif majeur de la fatigue est une douleur accrue qui consomme plus d’énergie et provoque une fatigue supplémentaire – un cycle auto-perpétuant de douleur et de fatigue. La fatigue nuit à notre capacité et à notre motivation à socialiser, à effectuer nos tâches quotidiennes et à effectuer notre travail correctement.

TRAITER LA FATIGUE

Il existe de nombreuses stratégies pour traiter la fatigue. La fatigue ne sera probablement jamais complètement éliminée, mais de nombreuses mesures peuvent être prises pour en contrôler les conséquences et minimiser son impact sur la vie quotidienne.

Votre médecin voudra peut-être commencer par rechercher des maladies sous-jacentes telles que l’hypothyroïdie, les troubles du sommeil, l’anémie et la maladie du tissu conjonctif, qui impliquent différentes approches de traitement. En l’absence de maladie sous-jacente significative, la fatigue peut être attribuée au syndrome de fibromyalgie (ou syndrome de fatigue chronique).

Parmi les laboratoires spécifiques que je commande fréquemment chez les patients atteints de fibromyalgie souffrant de fatigue importante, citons:

•  Numération sanguine complète  (pour évaluer l’anémie ou les troubles sanguins)

•  Taux de sédimentation  (à évaluer pour toute inflammation sous-jacente)

T4, niveaux de TSH  (à évaluer pour toute anomalie thyroïdienne)

•  Niveau de facteur de croissance 1 analogue à l’insuline  (pour mesurer les carences en hormone de croissance)

•  Magnesium RBC  (pour mesurer toute carence en magnésium intracellulaire).

Si les laboratoires se situent dans la plage normale, mais qu’ils sont bas / normaux, je peux en déduire qu’ils sont «anormaux» pour un patient donné. C’est-à-dire que le niveau du patient est encore trop faible pour ce qu’il a besoin, même s’il peut rester dans la plage normale.

Quelles mesures peuvent être prises pour minimiser les effets débilitants potentiels de la fatigue?

Vous trouverez ci-dessous une liste de stratégies que j’ai trouvées utiles.

1.  Développer de bonnes habitudes
de sommeil Un sommeil de qualité est nécessaire au corps pour fabriquer de l’énergie. Développez une bonne routine de sommeil. (Révisé au chapitre 22 de  La fibromyalgie: de près et personnel .)

2.  Évitez les longues
siestes diurnes Bien que la fatigue puisse parfois être convaincante, il est préférable d’essayer d’éviter de faire des siestes, car cela modifie le rythme de sommeil du corps. Les siestes sont souvent non rafraîchissantes et prennent beaucoup de temps. Au réveil, beaucoup de gens se sentent encore moins énergiques et ont plus de difficulté à repartir. Ils peuvent même avoir une période de confusion accrue et de trouble mental.

Chez certaines personnes, cependant, une sieste stratégique (moins d’une heure) permet d’atteindre son objectif en rafraîchissant et en restaurant l’individu pour lui permettre de mener à bien le reste de la journée. Tant que le sommeil nocturne principal n’est pas perturbé plus que d’habitude , ces siestes ne doivent pas être découragés.

Cependant, mon expérience (et les études sur le sommeil montrent) que la plupart des personnes qui essaient de vaincre la fatigue avec une sieste n’accomplissent pas l’humeur rafraîchissante et réparatrice qu’elles recherchent et que les habitudes de sommeil du soir sont perturbées.

3.  Une bonne nutrition
Une alimentation riche en protéines et en glucides a aidé de nombreuses personnes à améliorer leur énergie. Les régimes trop riches en matières grasses peuvent mettre le corps dans un état de paresse, mais si vous réduisez vos graisses au détriment de trop peu de protéines, vous risquez d’être plus fatigué. Trouvez votre équilibre. (Pour plus de détails, voir «Pourquoi le gain de poids est un problème de fibro et comment y remédier».)

4.  Suppléments naturels – et médicaments sur ordonnance
Les douzaines de suppléments naturels annoncés pour augmenter l’énergie sont efficaces pour certaines personnes. Cependant, de nombreux produits énergétiques contiennent de la caféine ou de l’éphédrine, des stimulants qui peuvent avoir des effets néfastes à long terme sur le corps et peuvent être dangereux s’ils sont pris ensemble. Avant d’essayer un produit énergétique naturel, je vous recommande de consulter votre médecin au préalable.

• Je recommande une  combinaison de magnésium et d’acide malique  et le  colostrum  comme les deux meilleurs suppléments pour améliorer le niveau d’énergie. Les combinaisons de magnésium et d’acide malique agissent en augmentant l’énergie formée dans le muscle. Le colostrum favorise l’amélioration du métabolisme et de l’énergie en augmentant les niveaux d’hormone de croissance.

• Si le niveau de B-12 est faible / normal, je peux recommander de la  vitamine B-12 , sous forme de pastille, de sublinguale (sous la langue) ou d’injection. Les comprimés de B-12 peuvent ne pas bien absorber par l’estomac, alors que les autres formes de B-12 sont absorbées différemment (les losanges et les formes sublinguales sont absorbés dans le sang par les capillaires situés à la bouche et sous la langue). absorbé dans le sang par le muscle).

• Si la thyroïde est basse ou basse / normale, je peux vous prescrire  Armor Thyroid  le matin. Co-enzymeQ10 (CoQ10)  est un autre supplément qui peut aider à augmenter les niveaux d’énergie / ATP dans les muscles.

• Les médicaments prescrits qui augmentent les niveaux de sérotonine peuvent également contribuer à améliorer l’énergie. Ceux-ci comprennent les  inhibiteurs sélectifs de la recapture de la sérotonine (ISRS)  tels que le Prozac, le Zoloft, le Paxil, le Celexa, le Lexapro et l’Effexor.

• La  welbutrine  est un type d’antidépresseur différent qui augmenterait le taux de noradrénaline au lieu du taux de sérotonine. La norépinéphrine est importante pour améliorer notre concentration, notre concentration et notre énergie.

• Le  5-HTP  est un élément constitutif nutritionnel naturel de la sérotonine, qui peut aider à améliorer le sommeil et l’humeur et à réduire la douleur, contribuant ainsi à la fatigue. Le millepertuis  et le  SAM-e  sont d’autres antidépresseurs naturels à base de plantes qui peuvent aider à augmenter les niveaux de sérotonine. Si la dépression sous-jacente est un problème, votre médecin peut choisir de vous prescrire un antidépresseur, car l’amélioration de la dépression améliorera généralement également la fatigue.

• Certains médicaments sur ordonnance appelés  stimulants du système nerveux central  peuvent être prescrits par votre médecin en cas de fatigue extrême entraînant des problèmes fonctionnels débilitants. Ces médicaments sont similaires à ceux utilisés chez les enfants présentant un trouble de déficit de l’attention. Ils comprennent le Ritalin, Cylert et Provigil.

6.  Planifiez les activités prévues, en particulier le soir
La fin de l’après-midi et le début de soirée sont souvent les moments les plus difficiles pour les personnes fatiguées. Après le souper peut être une période particulièrement difficile, surtout si la personne s’assoit pour se détendre ou s’allonge pour lire le journal. Un «crash» et l’incapacité de faire une activité utile pour le reste de la soirée peuvent survenir.

Mon conseil est de planifier régulièrement une activité, en particulier après le souper, qui comprend des courses, des sorties, des visites ou tout simplement rester debout. Vous serez surpris d’apprendre à quelle fréquence un second vent viendra. Beaucoup de gens ont un rythme naturel qui provoque une perte d’énergie en fin d’après-midi et en début de soirée, mais l’humeur et le niveau d’énergie remontent ensuite.

Si vous êtes un oiseau de nuit, vous avez tendance à vous sentir mieux et plus énergique aux alentours de 21 heures et vous aurez peut-être quelques bonnes heures où vous vous sentirez alerte et pourrez accomplir beaucoup de choses.

Reconnaissez votre propre biorythme et profitez-en pour:

• Planifiez votre meilleur travail autour de vos points forts

• Et essayez de vous stimuler à travers les points faibles en vous impliquant dans une activité.

7.  Divisez votre tâche en petits projets au lieu d’un seul.
Faites-en un peu à la fois et faites-en plus au meilleur moment. Par exemple, le travail dans la cour peut être divisé en tâches spécifiques pour différentes nuits de la semaine. Vous pouvez tondre le gazon un soir, le dos un autre et couper le troisième soir au lieu de faire les trois en un jour. Si nous déménageons et décidons de faire notre propre emballage, il est beaucoup plus facile d’emballer une boîte par jour pendant les six semaines précédant la date du déménagement, que d’essayer de faire tout cet emballage un ou deux jours avant le déménagement. . Ce type d’autodiscipline est également nécessaire lors des vacances et de la décoration pour les vacances. (En fait, l’autodiscipline pourrait aider beaucoup de choses!)

8.  Effectuer des exercices et une relaxation réguliers Les
exercices augmentent l’endurance, la préparation cardiovasculaire et le sentiment de bien-être. En fait, l’exercice régulier est le meilleur moyen d’améliorer la fabrication d’ATP / énergie au sein de nos muscles. La relaxation diminue le stress et réduit la douleur. Une marche rapide de 30 minutes après le souper procure de l’exercice et une relaxation mentale tout en neutralisant le point bas du biorythme.

Il n’est pas nécessaire de rester parfaitement immobile pour se détendre physiquement et mentalement; en fait, cela augmente souvent la fatigue et la tendance à dormir. N’oubliez pas de vous détendre, pas de sieste.

9.  Établissez un programme quotidien et cochez les choses à mesure que vous les accomplissez
Prévoyez suffisamment de temps pour terminer la tâche. En gardant une liste structurée, vous avez une meilleure chance de vous motiver pour atteindre vos objectifs quotidiens.

10.  Déléguez des tâches aux autres
Une des meilleures techniques d’économie d’énergie connue consiste à demander à quelqu’un d’utiliser votre énergie pour faire votre travail! Bien que déléguer des responsabilités soit difficile pour beaucoup de gens, il y en a d’autres qui effectueront avec plaisir certaines tâches pour vous. Il est préférable d’être aussi indépendant que possible, mais il est préférable de permettre à une autre personne de vous aider si cela signifie que vous aurez de l’énergie plus longtemps dans votre journée.

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