Pain is one of the causes of arthritis-related fatigue

“I’m so tired”: arthritis and fatigue

For many people living with arthritis, “I’m so tired” is an often spoken phrase. Fatigue is their constant, very unpleasant companion. It is a symptom which is often overlooked or overshadowed by other concerns when treating arthritis, but it can be life-altering to people living with the disease.

Often, research into treatments for arthritis has focussed on other disease symptoms, sometimes leaving out the importance of managing fatigue. Some recent research, however, has focussed on fatigue, why it is harmful, and how it can be better treated.

In an article published in Clinical Care in the Rheumatic Diseases, Basia Belza and Kori Dewing examined fatigue in arthritis and described some strategies for dealing with fatigue and minimizing its impact.
This article cites other research to conclude that 80 – 100% of people living with certain types of inflammatory arthritis, including rheumatoid arthritis, lupus, and fibromyalgia, live with fatigue. Most types of arthritis are associated with some fatigue, and it can be one of the most difficult symptoms to live with, and treat.

Fatigue has been defined as “usually or always being too tired to do what you want” (Wolf et al). For people living with extreme fatigue, completing even the simplest tasks, or participating in normal day to day activities, can feel nearly impossible. People who face fatigue as a symptom of their disease can simply feel “too tired” to do the things they want or need to do in their lives.

Causes of fatigue

There are several causes of arthritis-related fatigue, which very often occur together. Belza and Dewing note several causes of arthritis-related fatigue, including:

• Disturbed sleep, often caused by the pain associated with arthritis. This can lead to daytime tiredness.
• Inactivity, often due to the pain and swelling in joints and tissue associated with arthritis. This can lead to loss of strength and tone in muscles, which can make daily tasks more difficult.
• Pain, which can cause people to use up more energy to complete simple tasks, leading to fatigue.
• Medications, taken to control arthritis can cause fatigue; in fact, most arthritis medications list fatigue as a potential side-effect.

Managing Fatigue

It can feel impossible to take on anything else in your life when you are tired; yet there are some steps that you can take to reduce your fatigue and find a brighter, more energetic you. It might seem difficult, but including some or all of these strategies to your arthritis treatment plan could pay off, helping you lessen your fatigue.

• Cardiovascular exercise: studies have shown that aerobic training increases endurance, allowing you to do more and use up less energy.
• Strength training: the more you increase your muscle mass, the less energy you will need to expend as you go through your day.
• Keep track of your energy and fatigue levels: understand that you may have a finite amount of energy in your day, and be aware of how much energy you are expending on the tasks you need to complete. Take rest breaks and try to avoid “overdoing it”.
• Make sure you are using proper postures, equipment positioning, and tools. When in pain, or suffering from inflamed joints, people often use up more energy than they need to. Using adaptive tools in the kitchen and around the house, and making sure workstations are designed with the proper height of desk and chair, are examples of how you can reduce wasted energy.
• Practice good “sleep hygiene”: for some ideas about how to sleep better, read our “Tips for better sleep” article in this month’s JointHealth monthly.

Managing pain

There are many ways to help control pain. Some strategies focus on the physical and biological factors that influence pain, while others address emotional and social reasons for pain. Often, using a combination of methods is the best way to control your pain. Below are some ways to manage pain:

• Medications to address symptoms of the disease
• Joint Protection: The use of a splint or a brace allows joints to rest and can protect them from further injury. It is best to speak to your physician, as well as a physical and/or occupational therapist to ensure a proper fit for your body.
• Massage can provide temporary relief from sore muscles, increase blood flow, warm painful areas of your body and help you to relax. As with all types of pain relief, speak to your physician first and make sure your massage therapist is informed about your disease.
• Weight loss: Research in osteoarthritis has shown that even losing small amounts of weight substantially reduces the development of osteoarthritis and the pain associated with osteoarthritis.
• Exercises such as swimming, walking, low-impact aerobic exercise, stretching and range-of- motion exercises can help to reduce joint pain and stiffness.
• Psychological and behavioural approaches: For some people, managing arthritis pain can be helped through the use of psychosocial and behavioural approaches such as cognitive behavioural therapy, coping skills training and educational programs such as the Arthritis Self Management Program.
• Surgery: For some people with arthritis, it may be necessary to have surgery on joints that are damaged and painful.