I have learned much about managing fatigue over the last four years since developing pelvic enthesopathy, a painful condition of the muscles and tendons in the groins and pelvis. Pain, restricted mobility, fatigue, and lack of physical and emotional stamina followed, and when I had to stop many of the things I used to do, I became very depressed as well as frustrated. I would like to share some of my thoughts on this topic and I hope someone might find them useful.
Fatigue, or tiredness, from feeling a bit under par to total exhaustion, is a common problem for people with chronic pain and it can have many causes. It may be directly related to the painful condition or the stress associated with having chronic pain; or due to another health problem; a medication; menopause; lack of sleep for any reason or a combination of causes.
Sometimes it can be very hard to let other people do things that are too much for us, whether permanently or temporarily, and it can be even harder to give up things we like to do. It is good to do what we can, but not good to wear ourselves out by ignoring the facts of our health situation. Try to be honest with yourself as well as family and friends and accept help from others or ask for professional help to arrange assistance.
General practitioners (GPs) are good resources to help find whether there is a treatable cause for fatigue. Perhaps tests might find a condition such as anaemia or thyroid disease causing fatigue; or medications could bring about tiredness as a side effect. Maybe hot flushes, anxiety and/or depression might be contributing to poor sleep or tiredness and treatment is warranted. It is also important to work with our GPs, pain clinic or therapists, to ensure that pain is being managed as well as possible so that the pain is not either making you more tired than necessary or interfering with sleep. If the pain is still uncontrolled while using the medications and other techniques that have been suggested, go back and talk again. If fatigue persists there are many things that we can do ourselves.
First: ensure you are sleeping as well as possible. Some suggestions are available at: http://www.sleepoz.org.au/files/fact_sheets/AT09%20-%20Sleep%20Hygiene.pdf.
Whether to sleep during the day is a vexed question. Some people find this interferes with their night-time sleep, and others feel much better for a short nap, saying they sleep better because they haven’t pushed themselves to keep going too long.
Another difficult issue is the use of sleeping tablets. While regular use is generally discouraged I find that, occasionally, when I am really exhausted after some bad nights, a tablet helps me get a good sleep and this is with my doctor’s agreement. Work out what’s best for yourself. Similarly, everyone must decide whether sleeping in a separate bed/room to your partner is useful at times when either is very tired, unwell, restless, needs to get up often during the night , or one snores. Realistic but sensitive handling of this issue is a sign of a good relationship.
Second: relieve physical and emotional stress by using regular relaxation routines; exercising within your limits; taking some fresh air and sunshine (important for Vitamin D too); resting without sleeping e.g. putting your feet up while reading, or lying down while listening to music.
Third: pacing is often suggested for people with limited stamina, and indeed everyone has limits within which they need to plan to maintain health and balance in life. Spacing appointments and activities across the week, instead of all together, allows time to recover in between. If you find you don’t need the space to recover after all, there’s a space to be spontaneous and do something you enjoy!
[The writer must confess to not always taking her own advice, and realising that things sometimes just happen despite our plans. That’s life!]