Fatigue syndrome

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Fatigue syndrome is a feeling of persistent tiredness, exhaustion and listlessness. It has a lasting effect on the lives of those affected and cannot be eliminated even with a lot of sleep. In some cases, fatigue is a side effect of chronic diseases such as cancer, rheumatism, AIDS, or the result of extraordinary stress (such as chemotherapy). Read everything you need to know about fatigue syndrome here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F43G93

Fatigue Syndrome: Description

The term "fatigue" comes from French and language usage and means tiredness or exhaustion. According to this, the fatigue syndrome is characterized by a persistent feeling of tiredness, exhaustion and listlessness, which cannot be dispelled by sleeping and resting too much. The life of those affected is permanently impaired by the permanent, extreme weariness. Fatigue syndrome is to be differentiated from chronic fatigue syndrome (CFS), which expresses itself similarly, but according to recent research it is an autoimmune disease.

Fatigue: frequency

It is not possible to say exactly how often the fatigue syndrome occurs. There are corresponding studies on the occurrence of persistent exhaustion in the context of various diseases. However, these are mostly based only on the subjective information provided by patients. Nevertheless, it is striking how often chronic fatigue is cited as a stressful symptom. According to this, well over half of all patients with multiple sclerosis (MS) suffer from fatigue. In Parkinson's patients, the proportion of those affected is between 43 and 60 percent, depending on the study; in cancer patients it should even be more than 90 percent, estimate various experts.

Fatigue is often confused with an independent neurological disease, Chronic Fatigue Syndrome (CFS). Both the causes and the physical signs differ, however, in some cases significantly.

Overall, representative studies show that the frequency of fatigue increases with age and that women are more frequently affected than men.

Fatigue Syndrome: Symptoms

The fatigue syndrome manifests itself in an insurmountable, persistent feeling of physical and / or mental exhaustion. Those affected feel physically and mentally less productive than before: Even "normal" physical activities such as brushing teeth, cooking, telephoning, attentiveness and memory are often perceived as hardly feasible. Fatigue patients feel disproportionately exhausted after such activities. Another decisive feature of fatigue is that extreme tiredness and exhaustion cannot be relieved by sleeping too much - those affected go to sleep exhausted and get up the next morning just as exhausted.

Exhaustion, which goes far beyond the normal level, often leads those affected to withdraw and limit their professional and private activities more and more.

Fatigue Syndrome: Causes and Risk Factors

There are basically three types of fatigue:

• Fatigue as a side effect of chronic diseases such as cancer, multiple sclerosis, Parkinson's disease, systemic lupus erythematosus, rheumatoid arthritis (“rheumatism”) or HIV / AIDS
• Fatigue as a result of other conditions such as severe sleep disorders, nocturnal breathing pauses (sleep apnea), persistent pain, thyroid disease, anemia, malnutrition, interferon treatment (for multiple sclerosis, hepatitis C or certain types of cancer) or chemotherapy (for cancer)
• Fatigue as an independent disease - doctors speak of chronic fatigue syndrome (CFS)

In some cases, the factors causing fatigue are known. In anemia, for example, the number of red blood cells that are responsible for transporting oxygen is reduced. As a result, the body cells receive too little oxygen, which among other things leads to a drop in performance and fatigue.

The development of fatigue as a side effect of chronic illnesses, on the other hand, is still unclear in most cases. However, experts suspect that there is no single trigger for persistent exhaustion, but rather that several factors contribute to fatigue (fatigue as a multifactorial event). Suspected include:

• Changes in the central nervous system (as in Parkinson's and multiple sclerosis)
• Changes in the endocrine system (hormonal balance)
• Dysregulation of the immune system (fatigue is a common symptom of autoimmune diseases such as multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus!)
• Inflammatory processes (as in rheumatoid arthritis and fibromyalgia)

Fatigue in cancer

The best researched is tumor-related fatigue, i.e. persistent exhaustion as a concomitant and consequence of cancer. Here, too, several factors play together in the development of fatigue, experts believe:

The cancer itself: The tumor can cause changes in the body that lead to fatigue. For example, the cancer cells can produce substances that cause tiredness and fatigue. The cytokines - certain proteins in the body - are suspected. Some types of cancer increase energy requirements, weaken muscles or interfere with hormonal systems - all of these factors can contribute to exhaustion.

Cancer treatment: surgery, chemotherapy, radiation, immunotherapy, and bone marrow transplantation can all cause fatigue. Chemotherapy, for example, not only destroys cancer cells, but also healthy cells and tissues, such as immune cells. A reduction in red blood cells (erythrocytes) leads to anemia - this is seen as the main cause of fatigue. A decrease in the number of white blood cells (leukocytes) increases the susceptibility to infections, which also weakens the body.

Cancer therapy has other side effects such as nausea, vomiting, pain, insomnia and psychological impairments - they are also considered to be (co-) causes of fatigue.

Other factors: The psyche also plays a role in cancer and the associated fatigue. Cancer diagnosis and therapy can trigger stress, anxiety, depression and sleep disorders. In addition, medication (such as pain relievers), malnutrition, and a lack of physical exercise can all contribute to fatigue. The same applies to hormonal changes in the course of cancer treatment, such as changes in thyroid, adrenal or sex hormones.

Fatigue Syndrome: Investigations and Diagnosis

To clarify any inexplicable fatigue, the doctor first asks about the medical history (anamnesis). For example, it is important to know how long the exhaustion began, how severe it is and how much it affects everyday life. In addition, the doctor asks about other complaints, sleep behavior, the use of medication, the consumption of alcohol, caffeine, nicotine and possibly illegal drugs as well as the professional, family and social situation.

This is followed by a physical exam, including a blood test. For example, it can unmask anemia as a trigger of fatigue.

Fatigue is a subjective symptom. However, there are a number of procedures (questionnaires, scales) that the doctor can use to assess exhaustion more objectively.

When clarifying fatigue, it is important to distinguish it from depression, because this can also cause severe tiredness and listlessness.

Fatigue Syndrome: Treatment

If there is an organic cause behind the fatigue, such as anemia (anemia), drug treatment is often possible. The same applies if, for example, severe sleep disorders, pain or thyroid disease are associated with fatigue.

It becomes more difficult when the cause of the persistent fatigue is completely unknown or several factors contribute to the development of fatigue, as is the case with many chronic diseases. Often, both medicinal and non-medicinal measures are used - together with individual counseling, which is intended to help the person concerned to cope better with the fatigue-related restrictions in their everyday life. The treatment of fatigue in cancer is mentioned as an example:

Medication

If anemia contributes to fatigue, red blood cells can either be supplied to the body from outside (blood transfusion) or the hormone erythropoietin (EPO), which is responsible for blood formation, can be administered. Both therapies improve the patient's performance and thus the quality of life, but have different advantages and disadvantages: A blood transfusion works faster, but carries various risks of infection and intolerance. The administration of erythropoietin is less risky, but only works after a few weeks and not in all patients. In addition, the hormone may only be administered in parallel with chemotherapy or radiation therapy.

Hormonal disorders (thyroid gland, adrenal glands) as a contributory cause of fatigue can also be treated with medication.

Mental moods are sometimes treated experimentally with antidepressants. However, these are currently not generally recommended because the effectiveness in fatigue has not yet been proven.

The drug treatment of fatigue, which primarily affects mental performance (concentration, memory, etc.), is also only just being tested. In the context of studies, the effectiveness of psychostimulants (such as the ADHD drug methylphenidate) is tested. However, it is still unclear whether they can really fix the concentration and memory problems.

Non-drug therapy

Exercise helps both the body and the soul. It is best to start exercise training under medical supervision at an early stage. Bicycle ergometers or treadmills are suitable devices. Exercise increases fitness, builds muscle mass and is also effective against depression and pain. According to the latest research, sport can also protect against relapses. Excessive rest has no positive effect on fatigue - on the contrary: physical performance would continue to decline.

Psychotherapy, especially behavioral therapy, can also be helpful for the psyche: In individual or group discussions, attempts are made to change behavior and experience patterns in such a way that fatigue is reduced and not further increased. However, it is important that patients find a professional therapist who is experienced in treating cancer fatigue.

These measures do not apply to people who suffer from chronic fatigue syndrome! With this similarly appearing, but completely different clinical picture, physical and mental exertion can lead to massive deterioration!

Fatigue syndrome: disease course and prognosis

In the case of fatigue due to an organic cause such as anemia or sleep disorders, successful treatment of the cause can often also eliminate permanent exhaustion.

Tumor-related fatigue can go away on its own; in many cancer patients, however, it persists even after therapy has ended. Depending on the type of tumor, up to 40 percent of patients continue to suffer from fatigue years after the end of treatment. For many, a return to normal everyday life or work is out of the question. Social life also suffers from the lack of drive, permanent exhaustion and lack of strength.

The same can apply to persistent exhaustion in the context of other chronic diseases. Treatment measures should then primarily help the patient to make optimal use of their limited physical, emotional and / or mental capabilities and to adapt the way of life to the restrictions caused by the fatigue syndrome as much as possible.

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