Fatigue plus pain: the double blow of fibromyalgia and what to do about it

Editor’s note: This extract originally appeared here in 2009, but given its importance, we publish it again for review.

Excerpted with kind permission from the very popular book by Dr. Pellegrino, Fibromyalgia: Up Close and Personal. * Dr. Pellegrino has seen more than 20,000 patients with FM in his practice at the Ohio Pain and Rehabilitation Center, and has been a fibromyalgia patient since childhood. .

Dr. Pellegrino explains that there are several factors that can influence the mixture that drains energy in fibromyalgia, but there are also many strategies to minimize their impact on daily life.

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In the CFS support groups and in the support groups for fibromyalgia that I have attended, both pain and fatigue are frequent topics of discussion … I think a person who describes their fatigue said it best. She said that her eyelids felt like cement weights and she felt like she was wearing cement shoes. Fatigue can be an overwhelming problem in fibromyalgia and, unfortunately, many people have the double curse, both severe pain and severe fatigue.

Why do patients with fibromyalgia (and CFS) have such a problem with fatigue?

There are multiple factors involved. These factors include:

1.   Non-restorative sleep disorder The
restoration that should occur during the deep stage of sleep is not happening. The manufacture of proteins, the replacement of energy reserves and the repair of tissues are incomplete. Sleeping badly leads to an increase in fatigue.

2.   Deconditioned
muscles Deconditioned muscles in fibromyalgia have lost their ability to produce the body’s energy molecules called ATP (adenosine triphosphate). This energy molecule is stored in our tissues, especially muscles, and is used as fuel to allow the body to perform all its functions, including muscle contractions.

The less ATP there is, the less energy is available and once the stored supplies are exhausted, fatigue occurs. If this process happens quickly, one can feel a sudden and unpredictable shock of energy. In fibromyalgia, our chronically low ATP contributes to chronic fatigue.

3.   Constant Pain
The body’s process of controlling pain, recording pain and expressing pain consumes energy and involves nerves, neurotransmitters and other enzymes and hormones. The patient with constant pain will consume more energy and have less stored energy than normal. (See “Fibromyalgia: ultimately an amplified pain disease.”)

4.   Decreased oxygen use in muscles
Studies have shown that muscles with fibromyalgia do not use oxygen as well as normal muscles. This may reflect a problem with muscle mitochondria, small organelles that use oxygen and make ATP. A biochemical problem can prevent the available oxygen from being used efficiently and appropriately to create ATP.

5.   Associated clinical depression Depression
is seen in almost half of patients with fibromyalgia and can cause extreme mental fatigue.

6.   Associated chronic conditions, such
as arthritis, hypothyroidism or another disease. People with fibromyalgia can have other conditions that consume a lot of energy and contribute to excessive fatigue.

7.   Cognitive factors
Fibromyalgia causes difficulties with concentration and attention, increased anxiety, greater sensitivity to depression and lack of attention. This is our fibrofog. (See “Managing Fibrofog – Cognitive dysfunction of fibromyalgia.”)

8.   Dysfunctional autonomic nervous system. 
We are more prone to anxiety and panic attacks, Raynaud’s phenomenon, rapid heart rate (especially in response to stress), skin rashes (especially in response to touch), tightness in the throat, irritable bowel syndrome , irritable bladder and other symptoms that are a consequence of an overly sensitized autonomic nervous system. Fatigue can also be a consequence of our dysfunctional autonomic nerves. (The autonomic nervous system maintains the “automatic” bodily functions performed by many organs, muscles and glands, and drives the responses to physical or emotional stress, fight or flight, see “Those dysfunctional autonomic”).

9.   visual overload
. I use this term to describe the overwhelming information that our eyes receive and have difficulty interpreting. (Revised in Chapter 4 of   Fibromyalgia: Up Close & Personal  .)

We try to detect a particular object, but we are faced with a variety of shapes, sizes, colors and lines in different directions that literally overwhelm our visual senses and sometimes cause a feeling of dizziness, dizziness and increased anxiety. I think this contributes to fatigue by demanding so much energy to sort this information.

10.   Decreased Respiratory Resistance
Many patients with fibromyalgia complain of shortness of breath with brief bursts of activity, such as climbing stairs, running or walking quickly. Actually, they may have difficulty recovering their breath. This respiratory condition may be due to the sudden fatigue induced by the exercise of the respiratory muscles that interrupts the respiratory rhythm.

The complaint seems to be independent of whether the person is out of condition or living a sedentary lifestyle. Since an efficient breathing process is necessary to supply oxygen to the bloodstream, any problem in this area will certainly create a potential for fatigue.

11.   Constant muscle movements
People with fibromyalgia often change their bodies to find more comfortable positions. The usual movements, such as hitting the fingers on the table, hitting or bouncing the feet on the floor, frequently crossing the legs and kicking a leg, are subconscious movements to relieve muscle stress, keep blood flowing and readjust muscles and posture . Try to decrease the pain. However, the side effect of these movement patterns is greater energy consumption.

12.   Hormonal problems The
decrease in the supply of hormones or the inefficient use of the available hormones can cause fatigue. Low-growth hormone and low thyroid levels are common in fibromyalgia and can decrease energy metabolism and, therefore, increase fatigue. The stress mechanisms altered in our body will increase energy consumption and interfere with the efficient use of energy, therefore fatigue worsens. Other hormones that can cause fatigue when they are scarce are estrogen and serotonin.

13.   Hypoglycaemia / Insulin Hypersensitivity
Our brains require a constant dose of glucose (blood sugar) and if our nutritional dysfunctions lead to hypoglycemia, our brains will react by saying: “You will feel bad until you get more glucose!” ( See discussion of hypoglycemia in “Why weight gain is a problem with fibro and what to do about it?”)

14. Low levels  of magnesium
Magnesium in cells is low in most patients with fibromyalgia. Magnesium is a key mineral in the formation of ATP / energy molecules in muscles. Low in magnesium means low ATP, which means more fatigue. (See “Nutritional approaches in fibromyalgia: deficiencies, symptoms, supplement strategies”).

15.   Candidiasis (yeast infection)
Under normal circumstances,   Candida albicans   lives in the intestinal tract of 80% of the human population without harmful effects. In fibromyalgia,   Candida   can grow excessively in the intestines and become “hostile”. This can lead to systemic symptoms, including fatigue. (See “Candidiasis – Yeast infection and nutritional repair”.)

Fatigue creates problems in our daily activities, regardless of the cause or causes. A major negative effect of fatigue is increased pain, which in turn consumes more energy and causes more fatigue, a self-perpetuating cycle of pain and fatigue. Fatigue interferes with our ability and motivation to socialize, carry out everyday tasks and perform our work correctly.

Treatment of the tongue

There are many strategies to treat fatigue. Fatigue will probably never be completely eliminated, but many things can be done to control its consequences and minimize its impact on daily life.

Your doctor may want to first investigate underlying conditions such as hypothyroidism, sleep disorders, anemia, and connective tissue disease that involve different treatment approaches. If significant underlying diseases are not present, fatigue can be attributed to the fibromyalgia syndrome (or chronic fatigue syndrome).

Some specific laboratories that I frequently request in patients with fibromyalgia with significant fatigue include:

•   Complete blood count   (to assess for anemia or blood disorders)

•   Sedimentation rate   (to evaluate any underlying inflammation)

•   T4, TSH levels   (to evaluate any abnormality of the thyroid)

•   Growth factor 1 level similar to insulin   (to measure growth hormone deficiencies)

•   Magnesium RBC   (to measure any intracellular magnesium deficiency).

If the laboratories are in the normal range but low / normal, I can interpret them as “abnormal” for an individual patient. That is, the patient’s level is still too low for what the patient needs, even though the level may be within the normal range.

What steps can be taken to minimize the possible debilitating effects of fatigue?

Below is a list of strategies that I have found useful.

1.   Develop good
sleep habits The quality of sleep is necessary for the body to produce energy. Develop a good sleep routine. (Revised in chapter 22 of   Fibromyalgia: Up Close & Personal  .)

2.   Avoid long
naps  during the day  Although fatigue can be convincing at times, it is better to try to avoid naps, as this alters the rhythm of the body’s sleep. Naps are often not refreshing and time-consuming. Upon awakening, many people feel even less energetic and have more difficulty getting back on track. They may even have a period of greater confusion and mental confusion.

However, in some people, a strategic nap (less than an hour) achieves its goal by renewing and restoring the individual to complete more successfully the rest of the day. As long as the main sleep of the night is not disturbed more than usual  , these naps should not be discouraged.

However, from my experience (and studies of sleep) show that most people who try to overcome fatigue with a nap do not really achieve the refreshing and restorative mood they seek, and the pattern of nighttime sleep is affected

3.   Adequate nutrition
A diet high in protein / low in carbohydrates has helped many people improve their energy. Diets too rich in fat can put the body in a lazy way, but if you reduce your fats at the expense of getting too little protein, you may have more fatigue, so find the balance. (For more information, see “Why weight gain is a problem with fibro and what to do about it”).

4.   Natural supplements and prescription drugs
The dozens of natural supplements advertised to increase energy are successful for some people. However, many energy products contain the stimulants caffeine or ephedrine, which can have long-term adverse effects on the body and can be dangerous if taken together. Before trying any natural energy product, I recommend checking with your doctor first.

• I recommend a   combination of Magnesium and Malic Acid,   and   Colostrum   as the two best supplements to try to improve energy levels. The combinations of magnesium and malic acid work by increasing the energy formed in the muscle. Colostrum promotes improved metabolism and energy by increasing levels of growth hormone.

• If the level of B-12 is low / normal, I can recommend   vitamin B-12  , either in pill form, sublingual (under the tongue) or in the form of an injection. B-12 pills may not absorb well from the stomach, while the other forms of B-12 are absorbed differently (pills and sublingual forms are absorbed into the blood from the capillaries in the mouth and under the tongue, and injection B-12 is absorbed into the bloodstream of the muscle).

• If the thyroid is low or low / normal, I can prescribe   Thyroid Armor   in the morning. Co -enzenzQ10 (CoQ10)   is another supplement that can help increase ATP / energy levels in muscles.

• Prescription medications that increase serotonin levels can also help improve energy. These include   selective serotonin reuptake inhibitors (SSRIs) such   as Prozac, Zoloft, Paxil, Celexa, Lexapro and Effexor.

•   Welbutrin   is a different type of antidepressant that reportedly increases the level of norepinephrine instead of the level of serotonin. Norepinephrine is important to improve our focus, concentration and energy levels.

•   5-HTP   is a natural nutritional component of serotonin that can help improve sleep and mood and decrease pain, all of which can help fatigue. St. John’s Wort   and   SAM-e   are other natural herbal antidepressants that can help increase serotonin levels. If the underlying depression is a problem, your doctor may choose to prescribe an antidepressant medication, since improving depression generally will also improve fatigue.

• Certain prescription medications known as   central nervous system stimulants  may be prescribed by your doctor in cases of extreme fatigue that cause debilitating functional problems. These medications are similar to those used for children with attention deficit disorders. They include Ritalin, Cylert and Provigil.

6.   Plan the scheduled activities, especially in the afternoon.
The afternoon and evening are the most difficult times for people with fatigue. After dinner it can be an especially difficult time, especially if the person sits down to relax or goes to bed to read the newspaper. There may be “shocks” and inability to perform any useful activity during the rest of the afternoon.

My advice is to routinely plan some activity, especially after dinner, which includes running errands, going outside, visiting people or simply staying on your feet. You will be surprised to know how often a second breath will come. Many people have a natural rhythm that causes little energy in the late afternoon and evening, but then the mood and energy level rise again.

If you are a nocturnal owl, you tend to feel better and with more energy around 9 p. M. And you can have some good hours in which you feel alert and you can achieve a lot.

Recognize your own biorhythm and use it to:

• Plan your best work around your high points

• And try to stimulate yourself through low points by engaging in an activity.

7.   Divide your homework into smaller projects instead of a large one. 
Do a little at a time and do more at your best. For example, work in the garden can be divided into specific tasks for different nights of the week. You can cut the front lawn one night, the other back, and cut back on a third night, instead of doing all three in one day. If we moved and decided to make our own packing, it is much easier to pack one box per day for the six weeks prior to the actual moving date, than to try to do all the packing one or two days before the move. . This type of self-discipline is also necessary to vacation and decorate for vacations. (Actually, self-discipline can help many things!)

8.   Perform regular exercise and relaxation
Exercise increases endurance, cardiovascular conditioning and a sense of well-being. In fact, regular exercise is the best way to improve the production of ATP / energy within our muscles. Relaxation decreases stress and reduces pain. An energetic 30-minute walk after dinner provides exercise and mental relaxation and counteracts the low point of biorhythms at the same time.

One does not have to sit perfectly still to relax physically and mentally; In fact, this often increases fatigue and the tendency to sleep. Remember to relax, not nap.

9.   Set a daily schedule and mark things as you do them
Allow enough time to complete the task. By maintaining a structured list, you have more possibilities to motivate yourself to achieve daily goals.

10.   Delegate tasks to others
One of the best energy saving techniques known is to have someone else use their energy to do their homework. While delegating responsibilities is difficult for many people, there are others who will gladly perform certain tasks for you. It is best to be as independent as possible, but it is better to let someone else help you if it means you will have energy for a longer part of your day. * * * *

Hopefully, some of these weapons can help you fight fatigue. Remember that fatigue, like pain, is a relative problem. (No, I do not mean cousin Vito!) The problem is always there, but you try to achieve a lower and more functional state that, in relation to the previous level, is considered a manageable and successful level.

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