There is More To Chronic Pain Disability Than Just Pain – the Fatigue

Others might content that if it’s just pain – take a pill and move on – but it’s more than that – it includes the fatigue

Eur J Pain. 2010 Mar;14(3):327-34.
Co-occurrence and associations of pain and fatigue in a community sample of Dutch adults.
Creavin ST, Dunn KM, Mallen CD, Nijrolder I, van der Windt DA. abstract here

  • 2447 participants
  • Persistent fatigue was reported by 60% of cases with chronic widespread pain.
  • Chronic widespread pain in 33% of cases with persistent fatigue.

Comment – fatigue can come in may flavors:

1) Drowsiness – this is judged by the epworth scale:

Scores of over 12 are abnormal. My daughter, Janice Montbriand and I did a study of sleep apnea in chronic pain subjects and found it high. A cheap test which might pick it up is nocturnal oxymetry – a finger meter device will count how many times an hour you desaturate you oxygen levels. 3 or less is normal over 8-15 needs a CPAP machine. 4 and up is controversal. This cheap test is available through Vitalaire in Regina for about $70.00. Prairie oxygen does more involved testing (with chest and nasal sensor as well)for maybe 170.00. Unfortunately opioids can cause worsening of sleep apnea.

Some people are excessively drowsy on opioids and stimulants like Ritalin are helpful for that.

2) Mental confusion – this is also high and can result from the disease, lack of sleep, and antidepressants one is on, opioids, mood, and so on. This is a hidden disability that has a bigger effect than can be readily seen. Attempting to work shows this well -can’t remember instructions, get things wrong. slow to work and so on.

3) Fatigue – I check of low testosterone levels in both men and women as sleep apnea can make these levels worse.

4) Depression – depression in chronic pain could be damaging to the brain and needs to be addressed. For those who can’t tolerate anti-depressants, I have been putting together a list of herbals that can be used: Checklist of Simple Treatments For Depression
5) Deconditioning – one needs to at least walk around the block everyday… Water aerobics are available in town either through the arthritis society or through water moves at southeast leisure center.

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