Posted by TENA/DIAMOND on 9/25/2009, 10:55 pm
Fatigue plus Pain – Fibromyalgia’s Double Whammy and What to Do About It#1 #1
#1by Dr. Mark J Pellegrino, MD
September 8, 2009
Excerpted with kind permission from Dr. Pellegrino’s very popular book,
Fibromyalgia: Up Close and Personal.* Dr. Pellegrino has seen more than 20,000
FM patients in his practice at the Ohio Rehab Center, and has been a
fibromyalgia patient himself since childhood.
Multiple factors can play into the mix that drains energy in fibromyalgia, Dr.
Pellegrino explains, but there are also many strategies to minimize their impact
on everyday life.
_________________________
In CFS support groups and fibromyalgia support groups I have attended, both pain
and fatigue are frequent topics of discussion... I think one person describing
her fatigue said it best. She said her eyelids felt like cement weights and she
felt like she was wearing cement shoes. Fatigue can be an overwhelming problem
in fibromyalgia, and unfortunately, many people get the double curse – both
severe pain and severe fatigue.
Why do patients with fibromyalgia (and CFS) have such a problem with fatigue?
There are multiple factors involved. These factors include:
1. Non-restorative Sleep Disorder
Restoration that should be occurring during the deep stage of sleep is not
happening. Manufacture of proteins, replenishment of energy stores, and repair
of tissues are incomplete. Poor sleep leads to increased fatigue.
2. Deconditioned Muscles
Deconditioned muscles in fibromyalgia have lost their ability to make the
body’s energy molecules called ATP (adenosine triphosphate). This energy
molecule is stored in our tissues, particularly muscles, and is used as fuel to
enable the body to perform all of its functions, including muscle contractions.
The less ATP around, the less energy available, and once the stored supplies are
used up, fatigue occurs. If this process occurs quickly, one may feel a sudden,
unpredictable energy crash. In fibromyalgia, our chronically low ATP contributes
to chronic fatigue.
3. Constant Pain
The body’s process of monitoring pain, recording pain, and expressing pain
isenergy consuming and involves nerves, neurotransmitters, and other enzymes and
hormones. The patient in constant pain will use up more energy and have less
stored energy than normal. (See “Fibromyalgia – Ultimately a Disease of
Amplified Pain.”)
4. Decreased Oxygen Use by the Muscles
Studies have shown that muscles with fibromyalgia do not use oxygen as well as
normal muscles. This may reflect a problem with the muscle mitochondria, the
small organelles that use oxygen and manufacture ATP. A biochemical problem may
prevent the available oxygen from being used efficiently and adequately to
create ATP.
5. Associated Clinical Depression
Depression is seen in nearly half of patients with fibromyalgia and can cause
extreme mental fatigue.
6. Associated Chronic Conditions
Such as arthritis, hypothyroidism, or other disease. People with fibromyalgia
may have other conditions that consume a lot of energy and contribute to
excessive fatigue.
7. Cognitive Factors
Fibromyalgia causes difficulty with concentration and attention, increased
anxiety, increased sensitivity to depression, and absentmindedness. This is our
fibrofog. (See “Managing Fibrofog – The cognitive Dysfunction of
Fibromyalgia.”)
8. Dysfunctional Autonomic Nervous System
We are more prone to anxiety and panic attacks, Raynaud’s phenomenon, fast
heart rate (especially in response to stress), rashes on the skin (especially in
response to touch), throat tightness, irritable bowel syndrome, irritable
bladder and other symptoms that are all consequences of an over-sensitized
autonomic nervous system. Fatigue can also be a consequence of our dysfunctional
autonomic nerves. (The autonomic nervous system maintains the "automatic" bodily
functions performed by many organs, muscles and glands, and drives responses to
physical or emotional stress - fight or flight. See "Those Dysfunctional
Autonomics.”)
9. Visual Overload
I use this term to describe the overwhelming information our eyes receive and
have difficulty interpreting. (Reviewed in Chapter 4 of Fibromyalgia: Up Close &
Personal.)
We try to spot a particular object but are confronted with a variety of shapes,
sizes, colors, and lines in different directions that literally overwhelm our
visual senses and at times cause a feeling of dizziness, light-headedness and
increased anxiety. I believe this contributes to fatigue by demanding so much
energy to sort out this information.
10. Decreased Respiratory Endurance
Many patients with fibromyalgia complain about their shortness of breath with
short bursts of activity such as climbing steps, running or walking swiftly.
They may actually have difficulty catching their breath. This respiratory
complaint may be from sudden exercise-induced fatigue of the respiratory muscles
that disrupts the breathing rhythm.
The complaint seems to be independent of whether or not the person is out of
condition or living a sedentary lifestyle. Since an efficient breathing process
is necessary to deliver oxygen to the bloodstream, any problem in this area will
certainly create potential for fatigue.
11. Constant Muscle Movements
People with fibromyalgia are frequently shifting their bodies to find more
comfortable positions. Habitual movements such as tapping fingers on the table,
tapping or bouncing the feet on the ground, frequent crossing of the legs, and
kicking out a leg are probably subconscious movements to relieve muscle stress,
keep the blood flowing, and readjust the muscles and posture to try to decrease
the pain. However, the side effect of these movement patterns is increased
energy consumption.
12. Hormonal Problems
Decreased supply of hormones or inefficient use of available hormones may factor
into fatigue. Low growth hormone and low thyroid levels are common in
fibromyalgia and can decrease energy metabolism and hence increase fatigue.
Altered stress mechanisms in our bodies will increase energy consumption and
interfere with efficient use of energy, hence fatigue is worsened. Other
hormones that can cause fatigue when in short supply are estrogen and serotonin.
13. Hypoglycemia/Insulin Hypersensitivity
Our brains require a steady dose of glucose (blood sugar) and if our nutritional
dysfunctions lead to hypoglycemia, our brains will react by signaling:
“You’ll feel lousy until I get more glucose!” (See discussion of
hypoglycemia in “Why weight gain is a problem with fibro, and what to do about
it.”)
14. Low Magnesium
Magnesium levels in the cells are low in most fibromyalgia patients. Magnesium
is a key mineral in the formation of ATP/energy molecules in the muscles. Low
magnesium means low ATP, which means more fatigue. (See “Nutritional
Approaches in Fibromyalgia: Deficiencies, Symptoms, Supplement Strategies.”)
15. Candidiasis (Yeast Infection)
Candida albicans is a yeast normally found in healthy intestines. In
fibromyalgia, Candida can overgrow in the intestines and become
“unfriendly.” This can lead to systemic symptoms including fatigue. (See
“Candidiasis – Yeast Infection and Nutritional Repair.”)
Fatigue creates problems in our daily activities, regardless of the cause or
causes. A major negative effect of fatigue is increased pain which in turn
consumes more energy and causes further fatigue – a self-perpetuating cycle of
pain and fatigue. Fatigue interferes with our ability and motivation to
socialize, carry out daily routine chores, and perform our jobs properly.
TENA/DIAMOND
People come into your life for a reason, a season or a lifetime.
A ROSE FROM MOM AND I !!
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