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How to deal with fatigue

Learn about normal fatigue, associated symptoms, cancer-related fatigue, management approaches, and self-care strategies. Explore graded exercise therapy, cognitive-behavioral therapy, and more to combat the impact of fatigue.

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How to deal with fatigue

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  1. How to deal with fatigue Saul BerkovitzMRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University College London Hospital NHS Trust

  2. “Everyday” fatigue • A normal sensation experienced by everyone • Exhaustion or tiredness (physical or mental) • Temporary and relieved by rest • Different from: • Weakness • Shortness of breath • Effort intolerance • Sleepiness • loss of motivation and pleasure

  3. Fatigue in the population • Main complaint in 5-10% of GP consultations • an important factor in another 5-10% • ‘TATT’ • Half of patients are still fatigued 6 months later

  4. Medically significant fatigue • Persistent or relapsing fatigue • Lasting several months • Not the result of over-exertion • Not relieved by rest or sleep • Causing substantial impact / disability

  5. Associated symptoms • sore throat • tender lymph glands • muscle pains • joint pains • new headaches • unrefreshing sleep • post-exertional malaise • poor memory or concentration

  6. Maintaining factors • Older age • Mood disorders • Illness beliefs • Inactivity • Sleep problems • Search for legitimacy, benefits, diagnostic label

  7. Cancer-related fatigue • Variety of cancers • Before diagnosis (40%) • During treatment (80-90%) • Beyond treatment completion (33% at one year) • High impact (more than pain, depression, nausea)

  8. Possible mechanisms of fatigue • Alteration in serotonin (“happy hormone”) • Alterations in cortisol (“stress hormone”) • Alterations in circadian rhythm (“biological clock”) • Alterations in muscle metabolism

  9. Approach to management • “Biopsychosocial” rather than “biomedical” • A definite diagnosis • Over-investigation vs. under-investigation • Empathy • Non-judgemental style • Commitment to continued care if required • Associated anxiety & depression

  10. Management – drug treatment • Anaemia (epoetin alpha) • Antidepressants • Night time sedation (amitriptyline) • Corticosteroids • Psychostimulant (methylphenidate (Ritalin)) • Wakefulness enhancer (modafinil) • Metabolic enhancer (L-Carnitine)

  11. Management – non-drug treatment • Self-management • Professional management • Multidisciplinary; integrated; group or individual • Activity management therapy • Graded exercise therapy (GET) • Cognitive behavioural therapy (CBT)

  12. Activity Management Therapy

  13. Activity management therapy • Pacing advice • Activity diaries and scheduling • Energy conservation • Stress management + relaxation training • Management of sleep problems • Longer term target setting • Coping with setbacks

  14. Graded exercise therapy

  15. Graded exercise therapy • Appropriate exercise is safe and beneficial in fatigue • Gradually progressed exercise programme starting from an individualised baseline • Assessment • Aerobic exercise, strength training, core stability training and stretching • Gym / home • Short- and long-term goal setting

  16. Cognitive Behavioural Therapy

  17. Cognitive behavioural therapy • How thoughts and feelings influence behaviour (and affect health and well-being) • Aims to promote self-management • Short-term • Collaborative • Problem-solving • Goal-focused • Individual or group

  18. Cognitive behavioural therapy • Unhelpful beliefs / thoughts about illness • “Activity makes me feel worse, so it will damage me” • “I can’t do X as well / often as I used to so I won’t do it any more” • “I can’t do X any more so I’m a failure” • Guilt / denial / embarrassment • Overestimating threats (catastrophising) • “I might collapse in the street so I won’t risk going out” • Over-vigilance of symptoms • Shift away from the pursuit of cause • Functioning the best we can within our constraints

  19. Self-management • Pacing • Graded exercise • Stress and mood management Fatigue services: www.afme.org.uk/me_cfsDirectorySearch.asp Books: “Fighting Fatigue: Managing the Symptoms of CFS/ME” by Sue Pemberton Computerised CBT: www.fatiguefighter.org.uk

  20. Acknowledgements • Chronic Fatigue Team, Royal London Hospital for Integrated Medicine • Chris Perrin (Nurse Specialist) • Mary Queally (Occupational Therapist) • Margaret Hooper / Raj Sharma (Psychologists) • Esther Odetunde (Physiotherapist) • Sue Thurgood (Dietician)

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