What Can I Do About Pain Related Fatigue

Today's post from webmd.com (see link below) may seem like another simplistic self-help post, aimed at  the general public rather than those living with chronic pain but the fact is that many many people living with neuropathy are often desperately tired. Either from the constant pain, or from weakness caused by over-activity that others would see as normal, it doesn't really matter. The point is, what can we do about it, if anything? Some of the tips shown below may well be helpful for you but as long as you're aware of the problem, you're more likely to take steps to help it. One thing is sure; without regular and quality sleep periods, your whole day will be affected by tiredness - don't be ashamed to take naps when necessary and when your body tells you too. Far too many articles stress the need for exercise and activity and they are indeed helpful for neuropathy patients (however you may protest) but rest and recovery are equally important.
 

Why Am I So Tired?
WebMD Feature Reviewed by Jennifer Robinson, MD

Are you always tired? That’s no surprise in these tightly scheduled, overloaded times.

The good news is, it’s simpler than you might think to get your energy back. The trick is to figure out why you’re fatigued. Then you can learn what to do about it. 

5 Common Reasons for Tiredness

1. What you eat. A shot of caffeine and sugar can seem like quick fix when you need an energy boost, but it soon makes things worse. After your blood sugar levels spike, they crash. You end up more fatigued, not less.

A far better solution is a balanced diet full of fruits, vegetables, and lean protein.

“Most people feel like they're less tired if they eat a healthy diet," says J. Fred Ralston Jr., MD. He's a past president of the American College of Physicians. "Eating healthy also means you'll carry less weight, and obesity is a big contributor to fatigue.”

2. How much water you drink. Instead of that caffeine-filled, sugary drink, try a glass of water.

Mild dehydration affects your mood, and it makes you feel more tired, research shows. It can set in when you drink just a little less H20 than you normally do.

The Institute of Medicine recommends that men get about 125 ounces of water a day and women get 91 ounces. Those amounts include water from all foods and beverages.

3. How much you sleep.

Millions of Americans just don’t get the ideal 7 to 9 hours of snooze time. If you’re one of them, avoid caffeine, alcohol, and large meals in the hours just before bedtime. Turn off the TV and unplug the computer before you turn in. Also, go to bed at the same time each night and keep your bedroom quiet and dark.

4. How much you exercise. Studies show that when inactive people start to work out, they feel much less fatigue than those who stay idle. When you move more, you not only use more energy, you also have more on a daily basis.

Ralston recommends you start with 30 minutes of exercise at least 4 days a week. Be sure to finish at least 3 hours before bedtime, so you have time to wind down. After a month, you should notice improvement in your fatigue. Within 3 to 6 months, you should feel much better.

5. What you do to handle stress. Stress is a fact of life. Fatigue sets in when you have more than you can handle. The first step in changing the way you deal with stress is to figure out your body’s stress signals -- aside from feeling fatigued, you might be angry, headachy, tense, or unable to focus.

Once you know how stress affects you, you can teach yourself to control it. Proven ways to limit the toll stress takes on you include:

Short, regular periods of meditation
Talks with friends or family about your challenges
Regular breaks from work
Taking time for yourself
Could It Be Something Else?

If you’ve taken steps to address all five of the most common causes of fatigue and you still feel worn out, visit your doctor.

Chronic tiredness is linked to medical conditions including these:

Anemia, or a lack of iron in the blood, is a common cause of fatigue, and it's easy to check with a simple blood test, says Sandra Fryhofer, MD. She's an associate professor of medicine at Emory University.

"It's particularly a problem for women, especially those who are having heavy menstrual periods,” she says.

An iron-rich diet that's heavy in meats and dark, leafy greens can correct low levels of iron. Ask your doctor if an iron supplement might help, too. Other key nutrients that can hold off fatigue include potassium and vitamins D and B12.

Thyroid problems. Both an over- and an underactive thyroid can cause fatigue. A blood test can help a doctor gauge how well your thyroid's working.

Diabetes. People who have uncontrolled diabetes "just plain don't feel good," Fryhofer says. "If you feel draggy and you're also having blurred vision or lots of urination, you should get that checked with a blood test."

Depression. If your feelings of exhaustion are accompanied by sadness and loss of appetite, and you just can't find any pleasure in things you once enjoyed, you might be depressed. Don't keep it to yourself. Your doctor, or a therapist, can start you on the path back to feeling better.

Sleep problems. Many different sleep issues can keep you from feeling rested and energized. Talk to your doctor about a sleep evaluation, especially if you snore, since that could point to a condition called obstructive sleep apnea, which briefly stops your breathing several times a night. Like other sleep disorders, it’s treatable.

Undiagnosed heart disease. Ongoing tiredness can be a warning sign of heart trouble, Ralston says. “If you have trouble with exercise you used to do easily, or if you start feeling worse when you exercise, this could be a red flag for heart trouble. If you have any doubts, see your doctor.”

http://www.webmd.com/fitness-exercise/features/reasons-tired

Fatigue A Neuropathy Problem

Today's post from neuropathysupportnetwork.org (see link below) is written by LtCol Eugene B Richardson whose good work we have featured before on the blog. It talks about an often underestimated side effect of neuropathy (and also HIV), fatigue. The article looks at various ways of dealing with this yourself, especially when family and friends are often less than understanding. Chronic fatigue can severely affect the quality of your life, especially over a long period and finding strategies to cope with it may lessen the accompanying depression and frustration.

 

Fatigue in Peripheral Neuropathy

Posted September 25th, 2012 by LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS

Unfortunately fatigue is a central part of many neuropathies and especially the immune mediated neuropathies. It is central to many other illnesses that affect the body’s immune system. The causes are often complex and many.

Dr. Scott Berman, in his book Coping with Chronic Neuropathy notes in chapter VIII “Dealing with Fatigue and Insomnia” that this symptom is one of the most difficult and challenging for the neuropathy patient. Dr. Berman is a Psychiatrist, a member of the Advisory Board of NSN, lives with untreatable CIDP.

He notes:

…that in one study looking at fatigue in autoimmune neuropathy 80% of 113 patients had severe fatigue. The fatigue was independent of motor or sensory symptoms and was rated as one of the top three most disabling symptoms. (“Fatigue in Immune-Mediated Polyneuropathies,” Neurology 53: 8 November 1999, I.S.J. Merkies, et al).

For decades in living with untreated Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Autonomic Neuropathy (AN) and Progressive Polyneuropathy due to exposure to Agent Orange in Vietnam, I can attest to the facts noted above. While other major symptoms respond to treatment with Immune Globulin (IVIg), the symptom of severe fatigue continues as one of the symptoms that responds only temporarily to the infusions followed by several days of total fatigue following infusion and then with some lessening until the next infusion.

Dr. Norman Latov in his book “Coping with Peripheral Neuropathy”, states what I have heard other neurologists share, that the fatigue we feel, first appearing as weakness, increases as the weakness of motor nerves expands. At this point with only a few muscles doing the whole job of lifting a leg or arm or carrying on autonomic functions, the body becomes weak and eventually extreme fatigue occurs.

On the other hand, to state the obvious, pain in some neuropathies does not help us sleep. Neuropathy patients must seek medical help in finding medications or other options which works for them. The medical establishment is slowly recognizing the reality of neuropathic pain and the strange symptoms from damaged peripheral nerves. Yet, as long as we do not have sufficient medical tools and clinical skills for diagnosis and treatment of the neuropathies, neuropathy patients will always face the challenge of dismissal for their often strange complaints.

Impact on family and friends:

Families and friends, as we all have learned, may not understand this reality since we “look so good” and may even believe/suggest that you are just lazy or unmotivated or worse. The best thing you can do for them is to have them watch the DVD Coping with Chronic Neuropathy which will be an education about the impact of any neuropathy on our lives.

Educating yourself about neuropathy:

At any rate, fatigue is something we struggle with every day and often regulates/determines our daily activities.

While fatigue in neuropathy and other chronic illnesses is not fully understood by the experts, from a practical standpoint, here is what I have learned to do or not do in coping with fatigue. If you have found other things that help, send us a message and we will add it to the list.

1. DO NOT think negatively about fatigue, thus feeling guilty about your fatigue. Go take a nap! (See DVD “Coping with Chronic Neuropathy”).
 

2. Learn when your “fatigue” periods occur, as these often establish a pattern at certain times of the day. Then go LAY DOWN and stop moaning about it, as it is what it is until it isn’t.
 

3. I have learned that you do not even have to actually “sleep”, but just allowing your body to rest/stop for an hour takes care of the exhaustion as the body recovers. But whatever works for you, do it without guilt or apology.
 

4. For nighttime, have a standard bedtime routine in preparing for sleep that tells your body that it is time to sleep.
 

5. Do not eat a large meal just before bedtime or take a stimulant that keeps you awake or might interfere with sound sleep (i.e. caffeine, for some alcohol).
 

6. Do consider drinking a glass of milk as for many this encourages the body to sleep.
 

7. Do consider one of those special recordings of quiet music or rain falling or similar if it helps.
 

8. Do consider using a ticking clock if that helps. (As a child in the 40s I got my best sleep on the floor in front of the big radio in the living room listening to Dragnet or was it the Lone Ranger, maybe the Big Story. Today most TV programs have the same effect, sleep!)
 

9. Muscle spasms and/or restless leg can make sleeping difficult and rob you of needed sleep. Speak to your doctor and have tests done for calcium, salt, potassium levels and other deficiencies which can make it difficult for muscles to work properly. This is especially true if you are on a diuretic which can empty your body of needed minerals. Getting up and having a glass of orange juice worked for my mother and works for me. If the lack of something is not the problem, have the doctor find out what may be causing these muscle problems.
 

10. I have found that if I wake up with my mind creating solutions to an issue or writing poetry (happens) and not able to sleep, I go to another room or go do some work on my computer (write out the solution or poetry) until I begin to feel sleepy again. It works for me.
 

11. For some insomnia is a real curse. There are medications that one can use as Dr. Scott Berman mentions in his book, so speak to your doctor. Frankly, I would work on natural solutions first and be creative to see what works for you. But if ALL else fails these medications may help and be a heaven sent blessing.
 

12. (So what do you do or not do that helps? Send it to us and we will enter it here!) (See original page/link below)

 

http://neuropathysupportnetwork.org/blog/2012/09/fatigue-in-peripheral-neuropathy

Coping With Neuropathy Fatigue

LtCol Eugene B Richardson continues to work tirelessly for better awareness of neuropathy and practical methods to alleviate the symptoms. In today's post from neuropathysupportnetwork.org (see link below) he talks about what to do when neuropathy drains all your strength or when your muscles just refuse to play ball. Don't let the military tone put you off - there are many good things to think about here - try to find something that works for you. Meanwhile the Neuropathy Support Network has a great deal of other information if you need it.

Fatigue and Neuropathy

Posted January 3rd, 2012 by LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS

PATIENT TO PATIENT – Disclaimer: Patient to Patient articles are intended to be educational, not diagnostic or prescriptive and the patient is encouraged to seek help from their own private physician.

Scott Berman, M.D. (Psychiatrist with CIDP) in his highly recommended book, Coping with Peripheral Neuropathy, How to Handle Stress, Disability, Anxiety, Fatigue, Depression, Pain, and Relationships, states on page 54 that “Fatigue is a fact of life for many neuropathy patients. Often our families and friends fail to appreciate this because ‘we look so good.’ In fact, in one study looking at fatigue in autoimmune neuropathy (“Fatigue in Immune-Mediated Polyneuropathies,” Neurology 53:8 November 1999, I.S.J. Merkies, et al), 80 percent of 113 patients had severe fatigue. The fatigue was independent of motor or sensory symptoms and was rated as one of the top three most disabling symptoms.”

Dr. Berman shares many practical ideas for adjusting to the realities of fatigue and insomnia in neuropathy. He serves as an officer on our Board of Directors and all proceeds from the sale of his book are donated to the Good Shepherd Rehabilitation Hospital in Allentown, PA. Scott’s book is noted in the RESOURCE tab of our website and can be ordered from there via www.amazon.com .

For decades now I have, like many of you, struggled with the fact of fatigue as one of the major components of my progressive polyneuropathy and found very little support or insight among too few medical professionals who often were more focused on what was NOT wrong rather than what IS wrong.

Poor medical attitudes toward neuropathy are still a major problem for patients in 2012! In the last two months I went on two major sites dedicated to helping patients and not one of them listed Peripheral Neuropathy as a major illness while more patients suffer from neuropathy than MS which is always listed! Why?

Recently a neuropathy patient struggling to understand the growing chronic fatigue shared his neurologists’ response and dismissive attitude as the doctor said, “take a nap” and then walked out. He asked, “Is this how far we have come in twenty years?”

So, what have I found works for me in dealing with the daily bouts of physical and mental fatigue?

FIRST, the importance of AFFIRMATION: No secret that I enjoy watching reruns of the Golden Girls TV show. Even my young grandson’s enjoy watching the humor which springs from the ordinary events of life Humor is one of the best foods for coping. Humor helps the body heal. This show brought great humor into my life with neuropathy. Then I discovered two special episodes on the recorded disc from season five. The two episodes are titled; “Sick and Tired” done in two parts, each one 30 minutes in length.

IDEA: Support group leaders and liaisons should consider using them to draw patients to support groups for discussion of the issues noted! ADVERTISE: Hear the Golden Girls on Fatigue, Failed Diagnosis and Humor at our Next Neuropathy Support Group Meeting!

You not only will enjoy the humor, but you will identify with Bea as she struggles to get a diagnosis for her chronic fatigue symptoms and an affirmation for her illness. You will identify with her mental pain when dismissed by one neurologist. You will celebrate the joy because of the healing provided by her supportive family doctor. Especially important is the scene at the end of part 2, when Bea finds a very ‘professional way’ to get her point across to the neurologist. Neuropathy patients will not feel so alone and may discover a way to laugh while watching a role model of how to respond to the dismissing doctor! If you are a neuropathy patient, you will identify and understand the emotional dynamics and you may find some healing humor to boot!

SECOND, don’t fight fatigue or apologize for it, as you are guilty of nothing. Fatigue is a real part of your neuropathy and you and your family deserve support while finding ways to live with it by adjusting your activities or discovering ways to decrease it.

THIRD, take rest periods during the day. I have found that it is not so important to go completely asleep as it is to just let your damaged sensory and/or motor nerves rest and not struggle even if for only 30 minutes.

FOURTH, I have just learned something that Dr. Latov suggests for reducing the symptoms of autonomic neuropathy and the digestive symptoms that often accompany, for example,the alternating symptoms of constipation and diarehea. REDUCE CARBS in your diet. I have discovered if I eat a breads, pancakes, waffles, and pasta, my exhaustion is WORSE especially after eating. Makes sense as blood goes to stomach to help digestion. But by reducing carbs and focusing on fruits and salads I reduce these symptoms of autonomic neuropathy, along with the fatique, especially after meals and it helped me feel a bit stronger all day!

FIFTH, if your breathing is a factor in sleeping, for whatever reason, have a sleep study done. I need to use a BIPAP machine. The neurologist explained to me that my neuropathy was affecting the nerves that help the muscles around my chest support breathing and for years I woke up with severe headaches due to lack of oxygen when I intermittently stopped breathing at night.

SIXTH, Dr. Berman’s book speaks about the factor of insomnia and I highly recommend his book and read what he shares. Between living with strong medications and pain at night, it is not surprising that neuropathy patients may be sleep deprived just when they need sleep the most. There are topical creams for any burning pain at night and solutions for the leg cramps that neuropathy patients often experience.

SEVENTH, you must continue to advocate for a DIAGNOSIS and FINDING THE CAUSE for your neuropathy. Do NOT permit a diagnosis of “idiopathic neuropathy”. Armed with your history and the testing that is available, the doctor can provide a diagnosis on the type and effects of the neuropathy, which often point in the direction of the cause. Having carried the unhelpful diagnosis of idiopathic neuropathy for decades, while my peripheral nerves where being damaged and eventually destroyed, this diagnosis only means that one needs to look further!

http://neuropathysupportnetwork.org/blog/2012/01/fatigue-and-neuropathy/