Articles from prior issues of The Advocate

November/December 1998

Understanding Fatigue
by Jane Bradley, Great Lakes Publication Representative

BRET LAWLOR, M.D. DEFINED FATIGUE AS a subjective sensation of generalized tiredness and exhaustion. This feeling of extreme tiredness or exhaustion often involves muscle fatigue. It is the seventh most common symptom seen by primary care physicians. Women report fatigue more frequently than do men. The direct medical cost annually for treating fatigue is $300 million. The indirect costs are significant and unknown. Fatigue is one component present in rheumatologic/autoimmune diseases, hypothyroidism, acute and chronic infections, diabetes, cancer, multiple sclerosis, post polio syndrome, fibromyalgia, anemia, depression, anxiety, stress, pain and more.

Several of the symptoms of fatigue are overwhelming tiredness and the need to sleep, having no energy, loss of ability to concentrate, being too tired to think, and being unable to make a decision. Persons who report to be fatigued, have feelings of muscle aches, simple tasks seem too much to complete, have no tolerance for exercise and the symptoms tend to be amplified. Those who have an organic cause for the fatigue tend to be worse in the evening than in the morning. The fatigue is accentuated by activity. Those with a psychogenic cause for the fatigue feel worse in the morning and get better as the day progresses. Myasthenia Gravis is a classic disease associated with fatigue. True physiologic findings can be measured by a physician.There is a classic case of fatigued muscles from activity. Any disease which affects the central nervous system causes significant complaints of fatigue. Fatigue Impact Scale, Krups Fatigue Severity Score or Multidimensional Fatigue Inventory are ways used to measure a person’s fatigue.

Another way to measure fatigue even though it is subjective, is to have the person keep a daily log. When Disability Examiners complete residual functional capacities on claimants, fatigue should be considered under nonexertional capacity. This is a thing that is not considered under particular work, etc. Fatigue does affect the functioning of an individual in various activities. Complex tasks can cause a variety of fatigue, especially under stress. Decreased memory, poor concentration, and the inability to complete tasks directly attribute to fatigue.

Several studies have shown that memory loss is not a factor in fatigue. It just takes longer for a person to complete tasks and remember things. Physicians must distinguish symptoms of fatigue from the primary disease process and other causes worsening the disease process. These professionals can use laboratory tests, such as sed rate, T-4 (thyroid function), hemoglobin/hematocrit, glucose, white blood count, urinalysis, MRI, bone scan to check for arthritis or other bone pathology, EMG, EEG, and assess the patient for depression. Ways to help those with fatigue are to treat the coexistent variable; treat the primary disease process; use medication. Exercise such as low impact aerobics done with submaximal effort for at least 20 minutes several times a week helps. Weight training is deemphasized as this causes muscle fatigue.

The patient needs to plan his/her day; use an assistive device if needed; take naps or frequent rest breaks; avoid doing activities to a level of exhaustion; avoid stress and organize one’s life. Remember, fatigue can be exertional and nonexertional. It is difficult to assess. Fatigue has a significant impact on one’s daily life. The treatments for and strategies for combating fatigue are multidimensional.