When fatigue means much more than tiredness

FatigueEveryone feels tired, at the end of the day, as a result of 12-14 waking hours spent in physical and mental work plus emotional interactions. This kind of tiredness is relieved by a break from the daily work routine, doing something relaxing such as listening to music and a good night's sleep. Fatigue on the other hand is a type of chronic tiredness that is not so easily addressed.

What is fatigue?

Fatigue is a feeling of low physical and/or mental energy and motivation, at times accompanied by sleepiness, such that the patient finds it difficult to perform daily activities. This condition is often described as being tired all the time, lethargy, weariness, exhaustion, malaise, listlessness, lassitude and feeling worn out or run down.

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What is the difference between fatigue and just tiredness?

Fatigue, as compared to routine tiredness, lasts for a longer duration and does not reduce by physical and mental rest alone.

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What are the symptoms of fatigue?

Common symptoms of fatigue are weakness, low energy, constant tiredness, absence of motivation, struggle to concentrate and inability to start or complete any task. Variable symptoms include fainting (syncope), fast heartbeat (palpitations) and dizziness (vertigo). Symptoms that require urgent medical care are unexpected weight loss, lumps in the body, fever (> 101F), unusual bleeding and/or unresolved body pain.

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When does fatigue occur? Why should fatigue be taken seriously?

The occurrence of fatigue may be a warning sign of an undiagnosed health condition or else a consequence of long-standing disease or medical treatment. The most common causes of fatigue are presented in the table below.

Disease/Health DisorderExamples
Endocrine and metabolic disordersAnaemia, hypothyroidism, diabetes, electrolyte imbalance, obesity, irritable bowel syndrome
Infectious diseasesMononucleosis, hepatitis, tuberculosis (TB), HIV infection, influenza (flu), cytomegalovirus, malaria
Heart and lung diseasesHeart failure, low blood pressure, coronary artery disease, valvular heart disease, chronic obstructive pulmonary disease (COPD), arrhythmias, asthma, pneumonia
Mental health conditionsDepression, anxiety, grief, stress, eating disorders, drug or alcohol abuse
Sleep disordersSleep apnoea, insomnia, reflux oesophagitis, narcolepsy, working in shifts
Other health conditionsCancer, end-stage renal disease (ESRD), chronic fatigue syndrome (CFS), fibromyalgia, rheumatoid arthritis, systemic lupus, pregnancy, multiple sclerosis (MS)
MedicationsAntidepressants, anti-anxiety medications, blood pressure treatments, chemotherapy, radiation therapy, sedatives, antihistamines, steroids, painkillers

What is Chronic Fatigue Syndrome (CFS)?

Chronic fatigue syndrome (CFS) is a condition in which the patient experiences chronic severe fatigue of unknown cause (lasting for more than six months) along with a minimum of four other simultaneous symptoms. The specific symptoms associated with CFS are mental deficiencies, muscle or joint pain, headaches, sensitive lymph nodes, sore throat, poor quality sleep and feeling depressed after exercise. The cause and risk factors of CFS are unclear though it occurs more frequently in 40-50 year old women. Often viral infections and mental stress are implicated in CFS. Treatment choices target symptoms using antidepressants and sleeping pills. Other therapies include following a healthy lifestyle, physiotherapy and psychological counselling.

Fatigue Scale

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How is fatigue assessed?

Fatigue intensity scales measure the severity of fatigue experienced based on verbal, visual and number ratings provided by the patient. The underlying cause of fatigue is diagnosed based on a detailed medical history and physical examination. The suspected diagnosis is further confirmed by blood tests and imaging studies.

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What are the treatment options for fatigue?

Early detection of fatigue leads to a timely diagnosis of the underlying disease. Often a friend or family member is able to recognize a behaviour pattern which indicates that the patient is suffering from fatigue. The treatment for fatigue depends on the underlying cause of fatigue which may be physical and/or psychological. For example, anemia is treated with iron supplements, infections are treated with antibiotics and specific medications are used to treat diabetes, hypothyroidism or sleep apnea. In addition, a healthy diet and exercise are highly recommended. Recent research shows that iron supplements, even in the absence of anemia, may reduce fatigue in some women.

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Is fatigue preventable?

Fatigue prevention is possible by following a healthy lifestyle that prevents the development of most underlying diseases that lead to fatigue. The fundamentals of a disease-free lifestyle besides a healthy diet include stress management, regular exercise, minimal caffeine and alcohol intake, no smoking and good sleeping habits. In addition, proper and timely treatment of fatigue-causing medical conditions and monitoring the intake of related medications will reduce the chances of fatigue development.

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