Living with and beyond the fatigue that accompanies chronic pain

Fear of chronic pain is a natural reaction, but this emotion actually contributes to the pain cycle! Let’s figure out how to break the pain-fear cycle!


Fatigue and chronic pain tend to go hand in hand; often the fatigue can be harder to live with than the pain! Fatigue is not just feeling a bit tired, it’s feeling completely and entirely exhausted through every fibre of your being. This study describes fatigue aptly,

Fatigue has been defined as an overwhelming sense of tiredness, lack of energy, and feeling of exhaustion.

How common is fatigue with chronic pain?

Fatigue is very common across many chronic pain conditions; as many as three out of every four patients with chronic pain report fatigue, as explained in this study

In Chronic Fatigue Syndrome (CFS), the main symptom is fatigue itself, accompanied by other symptoms such as pain. While this post can be referenced for all chronic pain conditions, it’s a good idea to discuss any exercise regime with your doctor, especially if you suffer with Chronic Fatigue Syndrome as overexertion can worsen symptoms with CFS. 

What causes fatigue with chronic pain?

Depending on your lifestyle and your chronic pain diagnosis, there are various potential causes for chronic fatigue:

  • Inflammation

Inflammation is common in chronic pain conditions. Chemicals known as cytokines are found in inflamed areas of the body; these are the same chemicals released when the body has flu or other viruses, and they cause fatigue and sustain pain. This article explains, “The inflammatory cytokines and cells interact with the CNS (central nervous system): peripheral inflammation can provoke fatigue and pain

  • Pain itself

Being in pain can often make it difficult to get to sleep; with chronic pain, sleep is often restless and broken.  At night there are less distractions for your brain, so it’s harder to keep your focus off your pain when you are lying awake in bed. This study explains, “Pain perception tends to decrease when a person is distracted by other stimuli, so that chronic pain may be worse in the evening”

Often when chronic pain patients do get sleep, it’s non-restorative, meaning it hasn’t given the body the rest it needs. The body needs sleep to recuperate, to regain energy and function properly; without the right amount of restful sleep, fatigue rears its head.

This article explains that chronic pain and fatigue share the same pathways in the body, “muscle pain and fatigue are not independent conditions and may share a common pathway that is disrupted in chronic muscle pain conditions”. 

Inflammation, pain and fatigue seem to go hand in hand; they contribute to each other and work in a cycle. It seems that in chronic pain patients, as pain worsens so does fatigue, explained here, “High fatigue is most often associated with high pain, and fatigue and pain seem to be synchronous”.

  • Inactivity

Pain patients are often inactive due to fear of causing their symptoms to worsen; not only does this contribute to the pain cycle, it also causes fatigue. The less the body is active, the less the muscles are used including your heart and lungs; this leads to these muscles weakening. 

This loss of muscle mass, leads to strain on those weak muscles and other areas of your body when you do try to engage in activity; this leads to wear and tear and ultimately fatigue.

  • Stress

The body is not designed to withstand being in a prolonged state of stress; being stuck in a ‘fight or flight’ mode puts a lot of strain on the body. The body is overworked and this causes fatigue. 

The stress hormone cortisol is designed to be released at the beginning of the day to get the body energized and ready for action, gradually tapering off throughout the day to prepare you for sleep at night. With prolonged stress, the levels of cortisol become disrupted, leading to fatigue during the day and inability to sleep at night.

  • Medication side effects

A lot of the medications that may be prescribed to treat the symptoms of chronic pain such as strong painkillers like opioids; pills to help you sleep; muscle relaxants; antidepressants and anticonvulsants among others, have the side effect of fatigue.

  • Comorbid health conditions

Chronic pain conditions can make you more susceptible to other health issues. Often those who have a chronic pain condition will also have comorbid conditions, which can contribute to fatigue. 

  • Poor diet

Not giving your body all the nutrition and hydration it needs to be energized and ready to function will cause deficiencies; without the right fuel, the body will be fatigued.

  • Mental illness

Chronic pain often leads to mental health problems like anxiety and depression; mental illness can alter brain chemicals and hormones being sent around your body, often make you feel unmotivated and fatigued. This study found that, “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

How does fatigue really affect someone’s life?

Fatigue is one of the most debilitating symptoms to deal with for many people, myself included. It feels as though all the energy has been completely sapped from your body; it makes it hard to even get out of bed or walk across a room, never mind function daily. It’s as though your limbs are weighed down, making every action feel so much harder.

I live with fibromyalgia and fatigue comes as one of the main symptoms of the disorder. I often find that when my fatigue is at its worst, I can’t even keep my eyes open even when I am trying my hardest to function and to stay awake.

Fatigue can affect literally every aspect of someone’s life. It can affect whether someone is able to work; to engage in activities in day to day life; to interact with loved ones; to do things that bring them joy, basically to have a good quality of life. This study concluded that fatigue,

associates with all measures of distress, and is a predictor of work dysfunction and overall health status.

This all sounds very dire, but don’t lose hope; there are ways to lessen fatigue and to live a happy life.

  • Get your health checked

If you are experiencing fatigue and you have not addressed it with your doctor, it’s wise to bring it up and get your health checked. Your doctor may eliminate other causes of fatigue such as anaemia, to ensure that the fatigue is coming only from your chronic pain condition.

  • Ask your doctor about medication

If you are on medication it’s a good idea to ask your doctor about the side effects you might be experiencing; fatigue is a common side effect and there may be another medication you can take with fewer sedating qualities, or perhaps a way to reduce the medications that are causing fatigue.

If your medications do cause drowsiness and you need to keep taking them, then trying to take them later at night so that they can help you sleep rather than make you tired throughout the day can be beneficial.

There are medications that can help with fatigue as a symptom; discussing these with your doctor and doing your own research could be beneficial. Melatonin and other similar medicines can help you sleep better, therefore giving your body the restorative sleep it needs. Supplements, vitamins and minerals may be suggested if your doctor finds that you are lacking in any of these; this can give your body what it needs to produce energy. Some medications do increase energy; your doctor may prescribe these but ensure that you do your research to feel confident that they are right for you before taking them.

Don’t be afraid to ask your doctor questions if you are not sure about any medications, to talk about side effects and to advocate for yourself; you don’t have to put any medications into your body that you are not completely sure about.

  • Address your chronic pain

Ensure that you are doing all you can to address the root cause of your fatigue which is your chronic pain condition itself.

  • Monitor patterns in your fatigue

Monitoring when your fatigue is at its highest can allow you to see patterns; you can identify times in the day when you have the most energy and plan activities to utilize these times.

  • Maintain a good sleep routine

When sleep is challenging to achieve, it’s vital to give yourself the best chance possible. Going to bed and rising at the same day each day; winding down before bed; using relaxation techniques; keeping your bedroom comfortable; being active during the day and more, can all help you to sleep more peacefully.

  • Eat a nutritious diet

Ensuring that you are eating energy rich foods and healthy balanced meals to help your body fight fatigue. Replacing foods that contribute to inflammation or provide ‘empty’ calories like processed foods and junk food with healthy alternatives, such as fruits, vegetables and healthy proteins, can make a significant difference.

  • Drink enough

Dehydration is often overlooked; without the right amount of liquids your body can struggle just as much as without the right nutrients. Your body needs water to carry nutrients around your body, to help keep your digestive system moving, to help rid the body of harmful bacteria and more: every system in your body uses water!

Ensure that you are drinking enough each day; the recommended amount of liquid per day is an average of half a gallon although this is simply a guide and depend on how much activity you are doing and what the temperature is. This study found that even mild dehydration, “induced adverse changes in vigilance and working memory, and increased tension/anxiety and fatigue.

A great tip that a friend of mine recommended and which I have found really helpful, is to get a big bottle that holds the amount you need to drink each day; fill it up in the morning or the night before and it makes it really easy to keep track of how much you need to drink by the end of the day.

  • Avoid caffeine

Caffeine only gives you energy in the short term; it contributes to fatigue in the longer term. Caffeine activates your sympathetic nervous system, sending out adrenaline and getting your body ready for action, just like stress does; but this energy only lasts for a short time. Once that boost wears off you might be inclined to ingest more caffeine. If you use caffeine regularly, you are overstimulating your adrenal system and it actually leads to fatigue as explained here.

  • Stay active

Keeping your body moving through a good daily routine and regular exercise helps to keep your muscles strong and helps you build energy. It’s tough to exercise when you’re fatigued and in pain but working your way up gradually with gentle exercise can be beneficial.

  • Rest regularly

Finding a balance between pushing yourself to be active and understanding that it’s ok to take breaks in between activity is important. Allowing your body to rest helps it to refuel and get ready for the next period of activity, so it’s just as valuable as being active.

  • Reduce stress

Stress contributes to pain and therefore to fatigue, so reducing stress in life can reduce fatigue as well as pain. It can also help you to get better rest at night without so many things on your mind.

  • Maintain your mental health

Depression and anxiety can contribute to the pain and stress cycle, and cause fatigue. Dealing with any mental illness with the help of medical professionals is going to aid in reducing fatigue and giving you a better quality of life.

  • Use mindfulness or talking therapies

Using mindfulness techniques and therapies like CBT, can help you to reduce your pain, fatigue and other symptoms and get your life back.

Even though fatigue is a debilitating symptom, there are lots of ways that you can fight it and regain the quality of life you may have lost. You can take your life back! 

Please note: This article is made available for educational purposes only, not to provide personal medical advice.

References

  • The Clinical Journal of Pain, Jeffrey Ira Gold, Ph.D., Nicole E. Mahrer, B.A., Joyce Yee, M.D., Tonya M. Palermo, Ph.D. (2009) “Pain, fatigue and health-related quality of life in children and adolescents with chronic pain”
  • Arthritis Research & Therapy, Karine Louati, Francis Berenbaum (2015), “Fatigue in chronic inflammation – a link to pain pathways
  • The Journal of Rheumatology, Wolfe F , Hawley DJ , Wilson K , (1996), “The prevalence and meaning of fatigue in rheumatic disease.”
  • Arthritis Care and Research, Volume 65, Issue 6, Pages 862-869, S.A.A.van Dartel, J.W.J.
  • Repping‐Wuts, D.van Hoogmoed, G.Bleijenberg, P.L.C.M.van Riel J.Fransen, (2013), Association Between Fatigue and Pain in Rheumatoid Arthritis: Does Pain Precede Fatigue or Does Fatigue Precede Pain?
  • Practical Pain Management, Lawrence M. Probes, MD.,(2012), “Tiredness and chronic pain management”
  • Institute for Chronic Pain, Jessica Del Pozo, PhD, (2017), “Fatigue and chronic pain”

  • Science Daily, University of Iowa, (2008), “Biological Link Between Pain And Fatigue Discovered”

  • British Journal of Nutrition, Volume 106, Issue 10, pp. 1535-1543, Matthew S. Ganio, Lawrence E. Armstrong, Douglas J. Casa, Brendon P. McDermott, Elaine C. Lee, Linda M. Yamamoto, Stefania Marzano, Rebecca M. Lopez, Liliana Jimenez, Laurent Le Bellego), Emmanuel Chevillotte,Harris R. Lieberman, (2011), “Mild dehydration impairs cognitive performance and mood of men”
  • Sanford Bolton, Ph.D., Martin Feldman, M.D.,Gary Null, M.S.,Emanuel Revici, M.D., Linda Stumper, B.S.,”A Pilot Study of Some Physiological and Psychological Effects of Caffeine” 

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