Fatigue Syndrome

Fatigue syndrome: description

The term “fatigue” comes from French and linguistic usage and means fatigue or exhaustion. Thus, the fatigue syndrome characterized by a persistent feeling of fatigue, exhaustion and listlessness, which can not be driven away by much sleep and rest. The life of those affected is permanently impaired by the permanent, extreme weariness.

Fatigue: frequency

How often the fatigue syndrome occurs can not be said exactly. There are corresponding studies on the occurrence of chronic fatigue in the context of various diseases. However, these are usually based only on the subjective information of patients. Nevertheless, it is striking how often chronic fatigue is indicated as a distressing symptom. Thus, significantly more than half of all patients with multiple sclerosis (MS) suffer from fatigue. In Parkinson’s patients, the proportion of those affected varies between 43 and 60 percent depending on the study; in cancer patients, he should even be more than 90 percent, experts estimate.

Fatigue is often confused with an autonomic neurological disorder called Chronic Fatigue Syndrome (CFS). However, both the causes and the physical signs differ in part but clearly.

Overall, representative studies show that the incidence of fatigue increases with age and women are more frequently affected than men.

Fatigue syndrome: symptoms

The fatigue syndrome manifests itself in an insurmountable, persistent sense of physical and / or mental fatigue. Those affected feel less physically and mentally than before: even “normal” physical activities such as brushing their teeth, cooking, making phone calls, attention and memory are often perceived as hardly feasible. After such activities, fatigue patients feel disproportionately exhausted. A key feature of fatigue is that extreme tiredness and fatigue can not be alleviated by a lot of sleep – those affected go to sleep exhausted and get up the next morning just as beaten up.

Fatigue, which goes far beyond normal levels, often results in those affected withdrawing and further restricting their professional and personal activities.

Fatigue syndrome: causes and risk factors

There are basically three types of fatigue:

• Fatigue as a concomitant of chronic diseases such as cancer, multiple sclerosis, Parkinson’s disease, systemic lupus erythematosus, rheumatoid arthritis (“rheumatism”) or HIV / AIDS
• Fatigue as a result of other conditions such as severe sleep disturbances, nocturnal breathing (sleep apnea), persistent pain, thyroid disease, anemia, malnutrition, interferon treatment (in multiple sclerosis, hepatitis C or certain cancers) or chemotherapy (in cancer)
• Fatigue as a Disease – Physicians speak of Chronic Fatigue Syndrome (CFS)

In some cases, the triggering factors of fatigue are known. For example, in the case of anemia (anemia), the number of red blood cells responsible for oxygen transport is reduced. As a result, the body cells get too little oxygen, which among other things leads to loss of performance and fatigue.

In contrast, the development of fatigue as a concomitant chronic disease is still unclear in most cases. Experts suspect that there is no single trigger for the ongoing fatigue, but rather that several factors contribute to fatigue (fatigue as a multifactorial event). Suspects include:

• Changes within the central nervous system (as in Parkinson’s disease and multiple sclerosis)
• Changes in the endocrine system (hormone balance)
• Dysregulation of the immune system (fatigue is a common symptom of autoimmune diseases such as multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus!)
• Inflammatory processes (as in rheumatoid arthritis and fibromyalgia)

Fatigue in cancer

The best studied is the tumor-related fatigue, ie a prolonged exhaustion as a concomitant and sequelae of cancer. Again, there are several factors in the development of fatigue, experts believe:

The cancer itself: The tumor can cause changes in the body that lead to fatigue. For example, cancer cells can produce substances that cause fatigue and fatigue. Suspected are the cytokines – certain proteins of the body. Some cancers increase energy demands, weaken muscles, or interfere with hormonal circuits – all these factors can contribute to fatigue.

The cancer treatment: Surgery, chemotherapy, radiation, immunotherapy and bone marrow transplantation can all cause fatigue. For example, chemotherapy not only destroys cancer cells, but also healthy cells and tissues, such as immune cells. A reduction in red blood cells (erythrocytes) leads to anemia (anemia) – this is considered the main cause of fatigue. Reduction of white blood cells (leukocytes) increases susceptibility to infections, which also weakens the body.

Cancer also has other side effects such as nausea, vomiting, pain, insomnia and mental health problems – they are also considered (co-) causes of fatigue.

Other factors: The psyche also plays a role in cancer and the associated fatigue. Cancer diagnosis and therapy can trigger stress, anxiety, depression and sleep disorders. In addition, medications (such as painkillers), nutritional deficiencies and a deficit in physical training can contribute to fatigue. The same applies to hormonal changes in the course of cancer treatment, such as changes in the thyroid, adrenal or sex hormones.

Fatigue syndrome: examinations and diagnosis

To clarify an inexplicable fatigue, the doctor first asks the medical history (anamnesis). It is important, for example, since when the exhaustion exists, how pronounced it is and how much it interferes with everyday life. In addition, the doctor inquired about further complaints, sleep patterns, the intake of medication, the consumption of alcohol, caffeine, nicotine and possibly illegal drugs and the professional, family and social situation.

This is followed by a physical examination, including a blood test. It can, for example, expose anemia (anemia) as a trigger of fatigue.

Fatigue is a subjective symptom. However, there are a number of procedures (questionnaires, scales) that help the doctor to detect exhaustion more objectively.

Important in the clarification of fatigue is the demarcation to depression, because this can cause a strong tiredness and listlessness.

Fatigue syndrome: treatment

Is behind the fatigue an organic cause such as anemia, anemia, often a drug treatment is possible. The same applies if, for example, severe sleep disorders, pain or thyroid disorders are associated with fatigue.

It becomes more difficult when the cause of the prolonged exhaustion is completely unknown or several factors contribute to the development of fatigue, as is the case with many chronic diseases. Often, both drug and non-drug treatments are used – along with personalized counseling to help those affected deal better with the fatigue-related limitations in their daily lives. As an example, the treatment of a Fatigue in cancer called:

drugs

If anemia contributes to fatigue, the body may be given either red blood cells from outside (blood transfusion) or the hormone erythropoietin (EPO) responsible for the formation of blood. Both therapies improve the performance and thus the quality of life of patients, but have several advantages and disadvantages: A blood transfusion works faster, but carries various infection and intolerance risks. The administration of erythropoietin is less risky, but only after a few weeks and not in all patients. In addition, the hormone may only be administered in parallel with a chemo- or radiotherapy.

Also hormonal disorders (thyroid, adrenals) as a contributing cause of fatigue can be treated with medication.

Mood disorders are sometimes treated on a trial basis with antidepressants. However, these are currently not generally recommended because the efficacy in fatigue has not yet been proven.

Also under trial is the drug treatment of fatigue, which affects above all on mental performance (concentration, memory, etc.). In studies, the effectiveness of psychostimulants (such as the ADHD drug methylphenidate) is tested. Whether they can really solve the concentration and memory problems is still unclear.

Non-drug therapy

Exercise helps both the body and the soul. It is best to start early with exercise training under medical supervision. Bicycle ergometer or treadmill are suitable devices. Exercise increases fitness, builds muscle mass and also works against depression and pain. In addition, sport can also protect against relapse, according to the latest research. Excessive sparing has no positive effect on fatigue – on the contrary, physical performance would continue to decline.

Psychotherapy can be helpful for the psyche, especially a behavioral therapy: It is tried in individual or group discussions to change patterns of behavior and experience so that the fatigue goes back and is not amplified. However, it is important that patients find a professional therapist with experience in the treatment of cancer fatigue.

Fatigue syndrome: disease course and prognosis

In case of fatigue due to an organic cause such as anemia or insomnia, successful treatment of the cause can often also eliminate permanent fatigue.

Tumor-induced fatigue can go by itself; In many cancer patients, however, it also remains after completion of the therapy. Depending on the type of tumor, up to 40 percent of patients still suffer from fatigue years after the end of treatment. A return to normal everyday life or work is unthinkable for many. Social life, too, suffers from lack of drive, permanent exhaustion and lack of power.

The same may apply to prolonged fatigue in the context of other chronic diseases. Therapy should then primarily help patients to make the most of their limited physical, mental and / or mental capacity and to shape their lives Fatigue Syndrome conditional constraints adapt as well as possible.