Fatigue
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Fatigue refers to a sensation of exhaustion during or
after usual daily activities, or a lack of energy to begin these
activities. Most people have fatigue at one time or another in their
lives. Fatigue may result from exertion, lack of sleep, or illnesses
such as colds. Fatigue is not extreme or persistent. Instead, it
generally goes away after getting more rest or recovering from a cold.
Chronic fatigue, however, occurs when symptoms of exhaustion or lack of
energy last over 6 months.
Chronic Fatigue Syndrome (CFS) is the medical name for a
condition of extreme and persistent fatigue. To have a diagnosis of
chronic fatigue syndrome (CFS), a patient must meet the following two
criteria: 1) have severe chronic fatigue for 6 months or longer with
other known medical conditions excluded by clinical diagnosis, and 2) at
the same time, have four or more of the following symptoms: substantial
impairment in short-term memory or concentration; sore throat; tender
lymph nodes; muscle pain; multijoint pain without swelling or redness;
headaches of a new type, pattern, or severity; unrefreshing sleep; and
discomfort after physical activity that lasts more than 24 hours. The
symptoms must have persisted or recurred during 6 or more consecutive
months and must not have predated the fatigue. When there is no apparent
explanation or cause of fatigue, such as a disease, a diagnosis of CFS
is given. Additional information on chronic fatigue syndrome is
available on the Web at www4.od.nih.gov/orwh/CFS-newhome.html and in the
resource section at the end of this paper.
The following information covers chronic fatigue-not
CFS-as a symptom of many diseases of the skin, muscles, and joints.
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Chronic fatigue is a symptom of many diseases that fall
under the NIAMS mission, such as rheumatoid arthritis, fibromyalgia, and
lupus. Although the cause of chronic fatigue is unknown, infection,
hormone levels, and stress are believed to play a role in its symptoms.
Chronic fatigue often results from sleep disturbance, usually insomnia,
in combination with chronic pain and depression. Stress, physical
inactivity, poor diet, and medications may also contribute to chronic
fatigue. Social and cultural factors are also believed to play a role in
chronic fatigue symptoms. People with mobility-limiting disorders often
experience chronic fatigue. Regardless of the cause, chronic fatigue has
a major impact on day-to-day functioning and quality of life.
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If you think you may be struggling with chronic fatigue,
it is important to discuss your symptoms with your doctor. Symptoms such
as anxiety, depression, insomnia, and pain are particularly important to
discuss. It is also important to tell your doctor about any medications
you are taking, including dietary supplements and alternative and
complementary treatments, because some medications can exaggerate the
symptoms listed above. For example, stimulants (such as caffeine) as
well as corticosteroids may cause sleep disturbances. Your doctor can
provide guidance on what medications and interventions may restore your
sleep, as well as advice on medications to avoid. It is also important
to discuss chronic pain symptoms with your doctor because chronic pain
often leads to sleep difficulties, which in turn leads to chronic
fatigue. Your doctor may order laboratory tests to determine what
organ(s) may be involved in causing chronic fatigue.
Your doctor may recommend self-management strategies to
handle your fatigue. For example, the Arthritis Self-Help Course
(developed by the Arthritis Foundation) is an effective way to reduce
many symptoms of arthritis, including fatigue. Maintaining a healthy
weight and participating in regular exercise may also help reduce
symptoms of fatigue.
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Basic research has improved our understanding of what
factors - both within and outside the body - trigger the disease
process, and is important to understanding fatigue. It seeks to discover
how systems work and to develop a knowledge base that scientists can use
to achieve practical goals, such as treatments or cures for diseases. By
providing this new knowledge, basic biomedical research, such as that
supported by the National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), forms the foundation for advances in the
diagnosis, treatment, and prevention of diseases.
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Clinical and behavioral research helps scientists to
understand health and disease in humans. Improved understanding of
health and disease often allows scientists to translate research
findings into improved patient care. Clinical research includes clinical
trials, behavioral research, health services research, epidemiology
(where and how often a disease appears), translational research (which
moves basic advances into the clinic), and community-based research.
Clinical trials allow scientists to test interventions
designed to prevent, treat, or cure disease. For example, NIAMS-funded
researchers are following a set of lupus patients from three
well-defined ethnic groups-Hispanic, African American and Caucasian-as
part of the LUpus in MInorities: NAture versus Nurture (LUMINA) study.
So far, researchers have found that a variety of factors contribute to
increased fatigue in lupus patients. These factors include older age,
Caucasian ethnicity, lack of health insurance, inadequate coping
strategies, higher degree of disease activity, helplessness, and pain.
By understanding these factors, researchers hope to design therapies
aimed at overcoming this common and often disabling symptom. Researchers
also hope to uncover how and why fatigue occurs in certain individuals.
You can learn more about this trial and other clinical trials by going
to the Web site www.clinicaltrials.gov.
Behavioral research is designed to further our
understanding of behavioral functioning and provide knowledge needed for
better prediction, prevention, and control of diseases. The NIAMS
currently supports a clinical trial designed to test
cognitive-behavioral therapy as a treatment for insomnia in fibromyalgia
patients. Researchers hope the trial results will confirm the usefulness
of cognitive-behavioral therapy to reduce sleep disturbances, daytime
pain, and fatigue. Cognitive-behavioral therapy combines cognitive
therapy, which is designed to change or eliminate thought patterns that
contribute to the person's symptoms, and behavioral therapy, which aims
to help the person change his or her behavior. The NIAMS is also
interested in the use of cognitive-behavioral therapy for pain
management in other rheumatic diseases, as well as in low back pain.
Clinical and behavioral research, such as the studies
described above, have the potential to improve public health and enhance
quality of life. Since it is impossible to know with certainty which
area of research will produce the next important discovery, the
community of science, of which NIAMS is a part, has to be open to all
ideas. Discoveries can come from research funded in a variety of areas,
across a wide range of scientific disciplines.
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Self-Management Strategies Across Chronic Diseases-Program
Announcement (June 2000). This multi-institute Program Announcement (PA)
recognizes that self-management strategies have the potential to reduce
symptoms of fatigue for people with chronic diseases. It extends current
research to test the effectiveness of self-management interventions.
Developing standard approaches or best practices to self-management is a
major goal. Examples of approaches include cognitive strategies, social
support, improving self-efficacy, and coping skills.
Physical Activity and Obesity Across Chronic
Diseases-Program Announcement (November 2000). NIAMS and six other NIH
components issued this PA as part of a trans-NIH Obesity Initiative,
which includes approaches to obesity prevention and the
neuroendocrinology of obesity. Obesity, physical activity, and energy
level are interrelated and are thought to play a role in the development
of fatigue. Studies will include examining the quality-of-life benefits
of physical activity, which may include reducing fatigue.
Social and Cultural Dimensions of Health-Program
Announcement (December 2001). NIAMS joined several other NIH components
in issuing this PA to stimulate research in these areas. Some experts
believe that fatigue may be influenced by social and cultural factors.
By clarifying the relationship between social and cultural factors and
health and illness, the role of fatigue may be uncovered. The
announcement was based on recommendations submitted to the National
Institutes of Health (NIH) in conjunction with the 2000 conference,
"Toward Higher Levels of Analysis: Progress and Promise in Research on
Social and Cultural Dimensions of Health," held in Bethesda, Maryland.
Increasing Quality of Life in Mobility Disorders-Program
Announcement (May 2002). Recognizing that pain, fatigue, and depression
are common symptoms for persons with limited mobility, this
multi-institute PA seeks to stimulate research that will improve quality
of life for people with mobility disorders. It focuses on improvement by
managing the physical symptoms. Possible project topics are identifying
ways to improve life quality and psychosocial adjustment, and
determining factors that contribute to quality of life and positive
outcomes for individuals with mobility disorders.
Mind-Body Interactions and Health: Research Infrastructure
and Exploratory Development Programs-Requests for Applications (January
2003). The NIAMS and 14 other NIH components issued two requests for
applications (RFAs) to support and advance research to improve the
understanding of mind-body interactions and health. By promoting
collaboration among investigators conducting health-related mind-body
research throughout the United States, these RFAs will stimulate
innovative coordinated approaches to research questions. The NIAMS is
particularly interested in understanding the relationship between stress
and health consequences for people with arthritis, musculoskeletal
disorders, and skin diseases.
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Library of Medicine (NLM)
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of Research on Women's Health
Centers for
Disease Control and Prevention
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