1 / 23

How to deal with fatigue

How to deal with fatigue. Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University College London Hospital NHS Trust. “Everyday” fatigue. A normal sensation experienced by everyone

scorman
Télécharger la présentation

How to deal with fatigue

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. How to deal with fatigue Saul BerkovitzMRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University College London Hospital NHS Trust

  2. “Everyday” fatigue • A normal sensation experienced by everyone • Exhaustion or tiredness (physical or mental) • Temporary and relieved by rest • Different from: • Weakness • Shortness of breath • Effort intolerance • Sleepiness • loss of motivation and pleasure

  3. Fatigue in the population • Main complaint in 5-10% of GP consultations • an important factor in another 5-10% • ‘TATT’ • Half of patients are still fatigued 6 months later

  4. Medically significant fatigue • Persistent or relapsing fatigue • Lasting several months • Not the result of over-exertion • Not relieved by rest or sleep • Causing substantial impact / disability

  5. Associated symptoms • sore throat • tender lymph glands • muscle pains • joint pains • new headaches • unrefreshing sleep • post-exertional malaise • poor memory or concentration

  6. Maintaining factors • Older age • Mood disorders • Illness beliefs • Inactivity • Sleep problems • Search for legitimacy, benefits, diagnostic label

  7. Cancer-related fatigue • Variety of cancers • Before diagnosis (40%) • During treatment (80-90%) • Beyond treatment completion (33% at one year) • High impact (more than pain, depression, nausea)

  8. Possible mechanisms of fatigue • Alteration in serotonin (“happy hormone”) • Alterations in cortisol (“stress hormone”) • Alterations in circadian rhythm (“biological clock”) • Alterations in muscle metabolism

  9. Approach to management • “Biopsychosocial” rather than “biomedical” • A definite diagnosis • Over-investigation vs. under-investigation • Empathy • Non-judgemental style • Commitment to continued care if required • Associated anxiety & depression

  10. Management – drug treatment • Anaemia (epoetin alpha) • Antidepressants • Night time sedation (amitriptyline) • Corticosteroids • Psychostimulant (methylphenidate (Ritalin)) • Wakefulness enhancer (modafinil) • Metabolic enhancer (L-Carnitine)

  11. Management – non-drug treatment • Self-management • Professional management • Multidisciplinary; integrated; group or individual • Activity management therapy • Graded exercise therapy (GET) • Cognitive behavioural therapy (CBT)

  12. Activity Management Therapy

  13. Activity management therapy • Pacing advice • Activity diaries and scheduling • Energy conservation • Stress management + relaxation training • Management of sleep problems • Longer term target setting • Coping with setbacks

  14. Graded exercise therapy

  15. Graded exercise therapy • Appropriate exercise is safe and beneficial in fatigue • Gradually progressed exercise programme starting from an individualised baseline • Assessment • Aerobic exercise, strength training, core stability training and stretching • Gym / home • Short- and long-term goal setting

  16. Cognitive Behavioural Therapy

  17. Cognitive behavioural therapy • How thoughts and feelings influence behaviour (and affect health and well-being) • Aims to promote self-management • Short-term • Collaborative • Problem-solving • Goal-focused • Individual or group

  18. Cognitive behavioural therapy • Unhelpful beliefs / thoughts about illness • “Activity makes me feel worse, so it will damage me” • “I can’t do X as well / often as I used to so I won’t do it any more” • “I can’t do X any more so I’m a failure” • Guilt / denial / embarrassment • Overestimating threats (catastrophising) • “I might collapse in the street so I won’t risk going out” • Over-vigilance of symptoms • Shift away from the pursuit of cause • Functioning the best we can within our constraints

  19. Self-management • Pacing • Graded exercise • Stress and mood management Fatigue services: www.afme.org.uk/me_cfsDirectorySearch.asp Books: “Fighting Fatigue: Managing the Symptoms of CFS/ME” by Sue Pemberton Computerised CBT: www.fatiguefighter.org.uk

  20. Acknowledgements • Chronic Fatigue Team, Royal London Hospital for Integrated Medicine • Chris Perrin (Nurse Specialist) • Mary Queally (Occupational Therapist) • Margaret Hooper / Raj Sharma (Psychologists) • Esther Odetunde (Physiotherapist) • Sue Thurgood (Dietician)

More Related