Fibromyalgia Community

Our dear MiMI recently asked about fatigue and I wanted to discuss it a bit.

Fibromyalgia's top two symptoms are widespread pain and fatigue. If fatigue were cement, we would be freshly paved with particular heavy concentrations on our eyelids, arms, and feet!

There are multiple factors involved in our fatigue and they include:
1. Non-restorative sleep disorder. As we've previously discussed, restoration that should be occurring during the deep stage 4 of sleep is not happening. Poor sleep leads to increased fatigue.
2. Deconditioned muscles. Our fibro muscles are chronically low in energy molecules called ATP and our muscles do not use oxygen as well as normal muscles.
3. Constant pain. The body's process of monitoring pain, recording pain, and expressing pain is energy consuming so we use up a lot more energy.
4. Cognitive factors. Fatigue is influenced by our difficulty with concentration, attention, absentmindedness, i.e. our fibro fog.
5. Associated conditions contributing to fatigue. This could include depression, a co-morbidity of fibro, and non-fibromyalgia problems such as arthritis, hypothyroidism, etc. that consume a lot of energy and contribute to excessive fatigue.
6. Dysfunctional autonomic nervous system. This leads to dysfunctional breathing, increased heart rate and more stress responses, all of which consume energy or create oxygen delivery inefficiencies.
7. Hormone problems. People with fibro have lower growth hormone levels, usually have lower thyroid levels, and have insulin hypersensitivity and other hormone dysfunctions which decrease energy, metabolism and increase fatigue.
8. Deficiencies. This can include low vitamin D, low magnesium, low B12 and other key ingredients that are used to manufacture ATP or improve our metabolism.
9. Constant muscle movements. We are shifty people! I mean we frequently shift our bodies to find more comfortable positions. We also have habitual movements such as tapping our fingers, bouncing our feet or crossing/uncrossing our legs. The side effect of these movement patterns is increased energy consumption.

I find that fatigue is a difficult problem to treat. But there are many strategies for treating fatigue. Like your fibro pain, fibro fatigue will probably never be completely eliminated but you try to minimize its impact on everyday life. Your doctor will work with you to investigate for underlying diseases or other causes of fatigue.

What steps can be done? Here's a list of strategies I have found helpful:
1. Develop good sleep habits.
2. Avoid long daytime naps. Naps in general are non-refreshing, time consuming, and sleep rhythm disrupting.
3. Proper nutrition. We previously discussed dietary strategies.
4. Supplements. Examples of supplements that have been used include magnesium, vitamin D3, vitamin B12, coQ10, growth hormone, and 5-HTP. I believe supplements should be used only after discussion and recommendation by your treating doctor.
5. Prescribed medicines. These medicines are known as alerting agents and can include SSRIs, central nervous system stimulants, and other medicines under the direction of your treating physician.
6. Perform regular exercise and don't forget about regular relaxation.
7. Make a daily schedule and check off things as you accomplish them. Plan scheduled activities, divide your planned task into smaller projects instead of one big one.
8. Don't forget to follow proper fibronomics!
9. Delegate chores to others. This is one of the best energy saving techniques known where someone else uses his/her energy to do your task!

Hopefully some of these weapons can help you combat fatigue. And hopefully I didn't wear you out with this discussion!

Dr. P