CFIDS & Fibromyalgia Self-HelpFighting Fatigue (One in a series on treatment options for major symptoms of CFS and fibromyalgia. Other articles discuss treatment principles, pain, poor sleep and cognitive problems.) By Bruce Campbell Causes
of Fatigue The
fatigue associated with CFS and FM can have many causes. One is the
illness itself, which uses energy in attempting to heal. Others include:
Treating
Fatigue Perhaps the single most important key to controlling fatigue (and other symptoms of CFS and FM) is to adjust your activity level to fit the limits imposed by illness. This is often called “living within the energy envelope” or pacing. Rather than fighting the body, with repeated cycles of push and crash, you seek to understand your body’s new requirements and to live within them. Living successfully with CFS or fibromyalgia requires many practical adaptations, as you develop a detailed understanding of your new limits and then gradually adjusting your life to them. Each person’s limits will be different, depending mainly on the severity of their illness. Dr. Paul Cheney summarizes this approach well when he says, “Proper limit-setting, which is always individualized, is the key to improvement.” See Chapter 9 in our course text for instructions on how to define your energy envelope and Chapter 10 for pacing strategies. While
adjusting to limits means making many changes to daily habits and
routines, another part of the challenge of adjustment
is
psychological: accepting that life has changed and learning to see your
life in a new way. As described in another article,
this acceptance is not resignation, but rather an acknowledgment of the
need to live a different kind of life, one which honors the limits
imposed by illness. This
acknowledgment requires you to develop a new relationship to your body.
In the words of one person in our program, “Getting well requires a
shift from trying to override your body's signals to paying attention
when your body tells you to stop or slow down.” This
process of accepting limits and learning to live a different kind of
life usually takes several years and requires coming to terms with loss.
For ideas on how to move through loss to a new life, see Chapter
16. Strategies
for Treating Fatigue Due to… The rest of the article describes treatments, organized by causes of fatigue. Pain
and Poor Sleep Pain and poor sleep can intensify fatigue. Pain is inherently tiring and also tends to produce muscle tension, which, in turn, creates fatigue. Non-restorative sleep leaves you as tired in the morning as you were before going to bed. Treating pain and sleep using the strategies described in the next two articles in this series produces the bonus of reducing fatigue at the same time. The relationship between fatigue on the one hand, and pain and sleep on the other, works in the other direction as well. Just as treating poor sleep and pain can reduce fatigue, treating fatigue can have a positive impact on sleep and pain. For example, since feeling tired increases the experience of pain, reducing fatigue lessens pain. In sum, fatigue, pain and sleep interact with one another. An improvement in one symptom can have a positive effect on the other two. Probably the most common symptom to attack first is sleep. Activity
Level If overexertion is your problem, the most effective response is pacing, as described earlier. Pacing begins with defining your limits. You can do this in a general way by rating yourself on the CFS/FM Rating Scale. Your self-assessment suggests a safe daily activity level. If you wish to understand your limits in detail, for example how much exercise you can do or how much time you can spend with others, you can fill out the Energy Envelope form. For instructions, see Chapter 9. Once you have understood your limits, you can learn to live within them using pacing strategies, such as priority setting, rest breaks, short activity periods, living by a schedule, and managing special events, such as vacations and holidays. For more on pacing, see Chapter 10 and also the articles in the pacing archive. The archive includes both how to articles and patient success stories. Deconditioning If
being ill reduces your activity level and leads to deconditioning, you
may be able to start a spiral in the other direction with exercise
. Exercise produces a higher level
of fitness, thus reducing the fatigue caused by inactivity. It also
helps combat pain, lessens stress and improves mood. Exercise is usually
recommended for fibromyalgia patients and may also be helpful for CFS as
well. For more, see Chapter 12. Stress
and Emotions You can combat the fatigue coming from stress by using relaxation and other stress management strategies. Because stress is so pervasive in chronic illness and because it intensifies symptoms such as pain and poor sleep as well as fatigue, many patients use a variety of strategies to combat it. Like other self-management strategies, stress management techniques improve multiple symptoms. For more, including step-by-step instructions on several relaxation techniques, see Chapter 13. Powerful
emotions are part of chronic illness, a response to the disruption,
losses and uncertainty it brings. Emotions can be treated using a
combination of self-management strategies, professional help and
medications. Chapter 14
describes how to manage depression, anxiety and anger. Chapter
16 offers resources to help you move beyond grief. Nutrition CFS and fibromyalgia patients often experience several different kinds of problems getting good nutrition. First, because of energy limitations, lack of appetite or severity of symptoms, some people may not spend enough time to prepare and eat balanced meals. Getting help, freezing meals ahead of time and using prepared foods can help. Lastly, about one third of CFS patients, and a comparable portion of fibromyalgia patients, experience sensitivities to various foods or have difficulty absorbing nutrients. The most effective strategy for controlling food allergies is an elimination diet, in which foods are taken out of the diet and then reintroduced one by one. For more ideas on getting good nutrition, see Chapter 12. Medications
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