Many people suffer from an indefinable leaden fatigue for which no exact cause can be found. This chronic fatigue is called exhaustion syndrome or fatigue syndrome.
What is fatigue syndrome?
The term fatigue syndrome (French for “tiredness,” “exhaustion”) is a collective term for a number of different complaints for which no clear cause can be found. It is considered a systemic disease. The main complaints are a chronic feeling of tiredness, listlessness and persistent exhaustion, which severely restrict the quality of life of those affected. Doctors distinguish between different types of fatigue:
- Fatigue as an accompanying symptom of various chronic diseases (eg, multiple sclerosis, Parkinson’s disease, rheumatism, lupus erythematosus, AIDS).
- Fatigue in response to persistent sleep disturbance, sleep apnea, chronic pain, bleeding anemia, thyroid disease, malnutrition, interferon treatment for multiple sclerosis, hepatitis C, various cancers, chemotherapy
- Fatigue as an independent clinical picture, for example, chronic fatigue syndrome, but to be distinguished from fatigue syndrome.
Causes
The exact causes of fatigue syndrome are not yet sufficiently researched in detail, but in some cases triggers can be found such as anemia, which leads to fatigue and decreased performance due to a reduced oxygen supply. In many cases, fatigue syndrome is an accompanying symptom of various chronic diseases and is therefore difficult to narrow down. Experts often suspect not only one cause, but often an interplay of various causes such as changes in the central nervous system, hormonal changes, dysregulation of the immune system as in autoimmune diseases and inflammation. Fatigue syndrome is best researched in cancer and its treatment. Cancer is exhausting for body and soul and weakens patients through surgery, chemotherapy, radiation and bone marrow transplantation, because not only degenerated but also healthy cells are destroyed by cancer treatment. In addition, mental problems, depression and anxiety also play a role. Side effects of medication, diet and lack of exercise can also promote fatigue syndrome.
Symptoms, signs, and complaints
Many sufferers complain of persistent physical and mental fatigue for the first time after an infection. Even light exertion leads to fatigue and exhaustion. Breaks do not provide proper rest, and despite the persistent fatigue, sleep is not restful either; sleep disturbances may occur. Light everyday physical activities are already felt as exhausting and concentration and memory disorders may occur. In addition to these symptoms, other complaints such as headaches, muscle and joint pain, dizziness, swollen lymph nodes and loss of appetite may occur. Sufferers feel excessively exhausted and this exhaustion severely affects everyday life and quality of life. Many withdraw as a result. The symptoms can be long-term and so severe that they lead to disability in sufferers.
Diagnosis and progression
The diagnosis of fatigue syndrome is usually made by exclusion. In the case history interview, the physician first obtains a picture of situations in which the fatigue occurs, impairments in everyday life, use of medications, possible connections with caffeine, nicotine, or drug use, or stress in the family, job, or leisure time. Since excessive fatigue can be an accompanying symptom of various diseases such as hepatitis, depression and various types of cancer, these diseases must first be ruled out in order to be allowed to diagnose fatigue syndrome in the first place. Up to now, there are no reliable indicators for a fatigue syndrome. However, physicians with experience with the clinical picture can usually diagnose it quickly. For many of those affected, the complaints begin after an infection. Further indications for the physician are an increase in the complaints during physical or mental exertion and a duration of at least six months. The course depends on the underlying diseases. In the case of physical complaints such as sleep disorders or anemia, the complaints disappear after successful treatment.In cancer, the course depends on the severity of the cancer and the after-effects of treatment. In some patients, symptoms resolve in the long term; in some, they persist.
Complications
In most cases, the patient with fatigue syndrome suffers from severe fatigue for which no cause can be found in the first instance. This fatigue often cannot be compensated with sleep or rest and lasts for a long time. In many cases, it also leads to sleep disturbances and thus to psychological problems and depression. Due to the fatigue, it is no longer possible for the patient to carry out a normal daily routine, as they are severely restricted in their physical activities. Many patients experience dizziness, vomiting and nausea. Disturbances in concentration and coordination can also occur and thus also affect the profession practiced. In many cases, fatigue syndrome is accompanied by a loss of appetite, which can lead to underweight. For the body, being underweight is a very harmful symptom. The quality of life is affected by the fatigue syndrome, and most of those affected no longer participate in social events. In many cases, cancer leads to fatigue and must therefore be treated primarily. However, this can lead to various complications and death. In addition to physical problems, psychological complaints or stress can also lead to fatigue syndrome. These must be treated with a psychologist.
When should you see a doctor?
Anyone who suffers from chronic fatigue and exhaustion for no apparent reason may have fatigue syndrome. A visit to the doctor is necessary if the symptoms persist over a long period of time (at least four weeks) or even if new symptoms are added. Signs such as headaches, muscle and joint pain or loss of appetite at least indicate a serious underlying condition. A doctor must clarify whether this is chronic fatigue syndrome. If the persistent lack of energy and desire noticeably reduces the well-being and quality of life, a medical examination is recommended. Fatigue syndrome mainly affects people who are in a life crisis or who are faced with a particularly challenging task. A past infectious disease is also a possible trigger. Hormone disorders and complaints of the immune system as well as nervous disorders are also possible triggers. If these factors apply to you, it is best to consult a general practitioner. If psychological complaints are present, a visit to a therapist is recommended. In principle, the lifestyle must be adapted in the case of chronic fatigue syndrome – this is usually only possible with support. That is why physical or mental changes should be examined by a doctor and treated if necessary.
Treatment and therapy
Because of the unclear causes, there is still no therapy specifically aimed at fatigue syndrome, and medicine is pursuing different treatment approaches. For organic causes such as anemia, sleep disorders, thyroid disorders and pain, drug treatment helps in most cases. When diagnosis is difficult due to unclear causes or parallel symptoms, as is often the case with chronic diseases, drug and non-drug treatments are often combined with individualized counseling to help the patient cope with everyday life in the best possible way. Medications are tailored to the underlying disease. They are supplemented with psychotropic drugs and the patient is recommended moderate exercise training, because exercise is good for body and soul. Lack of exercise can be rather counterproductive in fatigue syndrome, because the physical fitness decreases even more due to rest, whereas physical exercise is a good protection. Accompanying psychotherapy, especially behavioral therapy, may be useful; for cancer patients, it is best to use a psychotherapist with experience in accompanying cancer therapy.
Outlook and prognosis
Nearly every oncology patient experiences prolonged periods of fatigue syndrome symptoms during treatment.The lack of deep sleep phases combined with frequent awakenings leads to declining muscle strength, general weakness, dizziness, listlessness and concentration problems, which in turn has a detrimental effect on therapy and compliance. However, only in very few cases does the fatigue syndrome persist. Many of those affected can observe improved sleep patterns in themselves and feel better just a few weeks after the end of therapy. If oncological patients maintain a regular day-night rhythm during treatment, be it cytostatic therapy, radiointervention or antibody infusion, prioritize positive activities in everyday life and pay attention to sufficient fluid intake, fatigue after cancer treatment can be a thing of the past. However, cases have also been documented in practice where patients continue to suffer from fatigue for months to years after oncological treatment, sometimes manifesting within depression or as a concomitant disease of dementia degeneration. However, this is very rare, so that patients can look forward positively to the future, especially after cytostatic therapy, after which, in contrast to all other cancer treatments, a fatigue syndrome can be observed disproportionately often. All symptoms of severe exhaustion after metastatic cancer, chemotherapy, severe viral diseases, burnout or multiple sclerosis are symptoms of a fatigue syndrome. Chronic fatigue syndrome (CFS), which is similar, represents a separate clinical picture in Germany. Depending on the trigger and physical condition, the prognosis for fatigue syndromes varies. Fatigue syndrome cannot be improved by plenty of rest or sufficient sleep. Fatigue is triggered by complex processes in the diseased or pre-damaged organism. If the malfunctions or deficiencies can be corrected in total, the prognosis is good in the medium term. Psychological care of the affected persons is indicated, since a fatigue syndrome can put a lot of stress on the affected persons. It usually makes it impossible to participate in life. The therapy of fatigue must cover many areas. Only complex treatment approaches can improve fatigue syndrome in the medium and long term. The disturbed inner-body regulatory circuits include blood formation, nutrient absorption and utilization, metabolic processes and the immune system. If suitable treatment options can be found here, fatigue syndrome can be completely cured in the long term. If this is not the case, the symptoms can at least be improved. In CFS, some patients recover. Others get worse and worse. Often, chronic fatigue syndrome runs in cycles and episodes. Many patients do not fully recover.
Prevention
Because in many cases fatigue syndrome is based on a chronic illness, specific prevention is difficult. Generally positive is a healthy lifestyle with a balanced diet and regular physical activity and adequate rest and sleep. If those affected notice that their physical and mental performance declines sharply over a longer period of time and does not improve despite appropriate self-measures, they should consult a physician to have the cause clarified.
Aftercare
In fatigue syndrome, options for aftercare are very limited. In this regard, affected individuals rely on purely sympathetic treatment for these symptoms, since causal treatment is only possible if the underlying cancer can also be treated. Self-cure cannot occur. Therefore, the treatment of the underlying disease is in the foreground in order to limit the fatigue syndrome completely. As a rule, treatment is carried out with the help of medications or by means of surgical intervention. When taking medication, care must be taken to ensure that the correct dosage is given and that it is taken regularly in order to completely alleviate the symptoms. Likewise, in the case of interactions and side effects, a medical professional should always be consulted so that no compilations occur. In the case of surgery, the patient should always rest after the procedure and take care of the body. Stressful or strenuous activities should be avoided, as should sports activities. Furthermore, a healthy lifestyle with a healthy diet generally also has a positive effect on the further course of the disease in the case of fatigue syndrome.Smoking and the use of alcohol and other drugs should also be avoided. Often, contact with other fatigue syndrome sufferers is also useful.
What you can do yourself
Physical activity can counteract the symptoms of fatigue syndrome. Regularly practicing endurance sports such as cycling, swimming, and running increases physical performance, and the endorphins released in the process relieve depressive moods. Sporting activity also creates a sense of achievement and increases self-confidence, which has a positive effect on mental balance. The training must not be too intense and must be increased slowly: Before starting, it makes sense to discuss the appropriate amount of training with the attending physician. A balanced diet with plenty of fresh fruit and vegetables prevents deficiency symptoms, and in some cases the intake of nutritional supplements may be indicated. Sufficient fluid intake is also important to keep the circulation going. Alternating showers and cold water poured over the forearms also stimulate blood circulation. To cope with everyday life, sufferers should pay attention to their body’s signals and schedule regular rest breaks. Keeping a daily diary can help to identify high-performance and low-performance phases and to plan the daily routine accordingly. A short nap often has a performance-enhancing effect – but it should not last longer than 20 to 30 minutes at the most, otherwise fatigue will increase. Exercise in the fresh air and regular ventilation of living and working spaces ensures an adequate supply of oxygen.
