Managing fibromyalgia-related fatigue

Fatigue is a state of physical and mental exhaustion that interferes with a person’s normal activities. A person experiencing fatigue may feel extreme tiredness, physical weakness, lethargy, apathy, difficulty concentrating, irritability, low moods, and forgetfulness. While experiencing fatigue, it can be difficult to manage—and also difficult to care about—everyday activities.

Short-term fatigue can be a normal response to stress, too little sleep, and physically demanding tasks. It’s a strong signal that the body needs fewer stressors and time to recover. This type of fatigue can typically be resolved with rest.

Fatigue is also associated with many health conditions, and it is a main symptom of fibromyalgia.

Fibromyalgia is a chronic pain disorder

Fibromyalgia causes pain in multiple sites throughout the body. This pain affects soft tissues like muscles, tendons, and ligaments. Common areas affected by fibromyalgia pain include the neck, upper shoulders, rib cage, chest, lower back, thighs, and arms, though pain can affect virtually any soft tissue in the body.

The cause of fibromyalgia is not fully understood, but it is considered a disorder of the central nervous system, where the brain interprets pain signals in an abnormal way. This creates a heightened sensitivity to pain.

The severity of pain can range from mild to intense. Pain can occur in flares or episodes, or it can be present most of the time.

Fibromyalgia can cause debilitating fatigue

In addition to pain, the other characteristic symptoms of fibromyalgia are sleep disturbances, mental cloudiness, mood changes, and fatigue.

People with fibromyalgia may have difficulty getting enough rest due to pain or coexisting sleep disorders like sleep apnea and restless leg syndrome. Even when getting adequate hours of sleep during the night, people with fibromyalgia often report not feeling well-rested. This may be due to the ways fibromyalgia can disrupt sleep phases and stages.

Disrupted sleep and non-restorative sleep can contribute to fatigue. Additionally, alterations to nervous system function that occur with fibromyalgia also disrupt fatigue-related signaling, communication between nerves and muscles, and cognitive processing (which can contribute to mental exhaustion). Fibromyalgia also impairs muscle function.

The takeaway from this is that the causes of fatigue in fibromyalgia are complex, and that fibromyalgia fatigue is different from other types of fatigue.

Managing fatigue in fibromyalgia

If you’re living with fibromyalgia, it’s important to understand that fatigue is not something that can be outworked and it’s not something that will improve on its own. Addressing fatigue is a major goal of treatment for fibromyalgia, and if you’re experiencing significant fatigue, you need to tell your healthcare provider.

A treatment plan for fibromyalgia will typically involve several strategies, and successful management often means finding the right combination.

Patient education

Patient education will help you understand the condition and also validate what you are experiencing. This is especially important because the main features of fibromyalgia—pain and fatigue—are “invisible” or “unseen,” meaning they cannot be measured with a test. Your healthcare team relies on you to describe these symptoms.

Improving sleep

Improving sleep is a critical focus of treatment and people with fibromyalgia should take steps to improve sleep. These include consistent sleep/wake times, quiet and calm sleeping environments, cool temperatures, and avoiding things that can interfere with sleep, like caffeine, nicotine, alcohol, large meals before bed, strenuous exercise two hours before bed, and electronic use within an hour before bed.

Additionally, a healthcare provider may prescribe a medication to help improve sleep and/or refer you to a sleep specialist for evaluations for sleep disorders. Always discuss the potential for adverse effects before starting any medication.

Mental health support

Low moods and anxiety are also symptoms of fibromyalgia, and many people with this disorder have a coexisting psychiatric condition. Mental health and social support are an essential part of treatment, and can include counseling, cognitive behavioral therapy, relaxation techniques, and other forms of support.

Physical activity

Resistance training, cardiovascular exercise, and movement therapy (such as tai chi or yoga) are recommended as part of treatment. Because activities that are too strenuous can trigger symptoms, your healthcare provider can assess your fitness level and exercise capacity and give you guidelines on how to exercise safely.

Pain relief

Medications to relieve and manage pain also play an important role in treatment for moderate-to-severe fibromyalgia or fibromyalgia that does not respond to nonpharmacological therapies. The choice of which medications to use will depend on symptoms and the severity of symptoms.

In addition to discussing the potential for adverse effects when starting a medication, make sure all your healthcare providers have an up-to-date list of all medications you take, including prescription medications, over-the-counter medications, and supplements (including herbal supplements). This helps prevent unintended drug interactions. A pharmacist is also a valuable source of information.

Fibromyalgia is a different experience for every person. What works for one person may not work for another, and finding the combination of therapies that works for you can take time. Your best source of information about a diagnosis, symptoms, and treatment will be a healthcare provider.