Chronic Pain and Chronic Fatigue


September 10, 2020

The Relationship Between Chronic Pain and Chronic Fatigue

Some people suffering from chronic pain may find themselves struggling with extreme fatigue, and vice versa. Individuals who suffer from chronic fatigue syndrome may find themselves experiencing muscle aches and increased pain. These may seem like two completely different issues, but it is not uncommon for individuals that suffer with one wind up with the other as well. The link between pain and fatigue lies within the body’s hypothalamic-pituitary-adrenal axis (HPA). Alterations in the function of the HPA system and the nature in which we respond to stress can cause symptom clusters such as fatigue or pain to be dominant. It has also been found that somatic symptoms, meaning, a person’s focus on the pain or fatigue, increase at night. This is because of the elevated levels of cortisol that leave the system at a faster rate than it can be produced. 

Cortisol is the leading stress hormone and its’ nocturnal activity levels cause individuals to have trouble sleeping. This leads to them focusing on their pain and inability to sleep, which results in fatigue the following day, and the cycle continues. 

Chronic Fatigue Conditions That Cause Pain Symptoms

One of the most common chronic fatigue conditions is myalgic encephalomyelitis (ME) also referred to as chronic fatigue syndrome (CFS). ME/CFS is a condition where people have a fatigue that is much more than just being a little extra tired. The fatigue can be severe and is not relieved by rest. Things like attending a school event for a child, taking a shower, or going to the grocery store can cause someone to experience a crash or collapse where they are unable to go on with daily activities for the rest of the day, sometimes even for the days to follow. Many people with ME/CFS have difficulty falling asleep and staying asleep which does not make their condition any easier to manage. In addition, pain is a very common symptom. The type of pain can vary but it is not usually caused by injury. Muscle aches and pains, joint pain, and headaches can be common in those with ME/CFS. 

Chronic Pain Conditions That Cause Fatigue Symptoms

Fibromyalgia is one of the pain conditions that is most closely associated with CFS. There have been alterations identified in the sympathetic nervous system in patients with fibromyalgia and CFS. 4 out of 5 fibromyalgia patients experience severe fatigue and trouble sleeping. Arthritis is another condition that results in extreme fatigue. Dealing with the pain of arthritis can be very tiresome and affect an individuals sleep habits, which adds to the fatigue. Fatigue and the inability for the body to properly rest and recover can make the pain more difficult to manage, creating this vicious cycle. 

How to Combat Fatigue and Pain

Although all chronic pain and chronic fatigue conditions may not be curable, they can be combated with various activities and treatments. One of the biggest struggles in inactivity. Patients are dealing with pain and exhaustion which leads to inactivity, but more inactivity causes more fatigue and joint stiffness. One study found that individuals with fibromyalgia who did more light physical activity  had lower levels of fatigue and pain than those who spent more time being sedentary. 

Ruling out anemia is another way to combat fatigue. Particularly in those with conditions like arthritis, a shortage of red blood cells can cause muscles to fatigue much faster. Up to two-thirds of people with arthritis have anemia, so it’s important to address this if fatigue has become a concern. In addition to ruling out conditions like anemia, diet plays a key role in regulating the body’s hormones, blood sugar levels, and fueling the body for success. Prioritizing drinking enough water and eating healthy whole foods may help decrease inflammation and bring regulation to the body to improve sleep quality.