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Physical Abilities and Energy

“I have low energy.” “I’m tired.” “I’m exhausted.” “I can’t think straight.” “I am so irritable.” “I just can’t get off the couch.”  These all point to fatigue. You are not alone.

  • Regular physical activity is essential to managing your chronic pain.
  • Avoiding triggers that worsen fatigue can help you find the energy and stamina to exercise.

Triggers that can worsen fatigue

  • physical inactivity (or being a couch potato)
  • stress
  • depression
  • anxiety
  • poor sleep
  • pain
  • muscle spasms
  • bladder or bowel problems
  • use of alcohol/marijuana
  • certain medications or medical problems

Steps to improve fatigue
Proven strategies to reduce fatigue include the following:

   Exercise.

  • Including regular exercise in your daily routine may reduce fatigue and help you sleep better, especially if you exercise several hours before going to bed.
  • Getting enough of the right kind of exercise can also help you stay sharp and focused.
  • Even if you have difficulty standing or walking, you can still exercise by following routines designed to be done while sitting in a chair (including chair-based yoga).    
  • A physical or occupational therapist can help design an exercise plan that works for you. It’s also a good idea to talk with your doctor about your exercise program to make sure it is safe for you.
  • Remember to take breaks and pace yourself so you don’t overdo or get overheated.

   Eliminate barriers to sleep.

  • There are concrete steps you can take to improve sleep. Think hard and honestly about what interferes with your sleep and work to eliminate them.
  • For example, if you have to get up several times during the night to pee, limit the amount you drink in the hour or so before going to bed.
  • Avoid drinking caffeine or alcohol, which can disturb your sleep cycle, before bedtime.
  • Turn off your computer and avoid your phone screen a few hours before going to sleep.
  • Drink a calming herbal tea or engage in a calming activity to help you unwind before bed.

   Eat right.

  • What you eat and drink can interfere with sleep and increase fatigue.
  • Foods and beverages to avoid before bedtime include caffeine, fatty or sugary foods, and alcohol. There may be others. Listen to your body for signs of what works for you.
  • Set a cut-off time for eating and drinking; the timing depends on how your body reacts. It may take some trial and error to figure it out.

   Manage Stress.

  • Identify sources of manageable stress and learn ways to deal with them.
  • While some sources of stress—like having chronic pain or grieving a loss—cannot be avoided, other stresses—like watching an upsetting movie or looking at FacebookTM—can be avoided.
  • You may benefit from psychotherapy to help you identify ways to reduce your stress.
  • Doing things that help you relax or bring you joy is another way to reduce stress in your life. Such activities may include walking, reading a book, yoga, having a pet, having a hobby, gardening, music, journaling, joining a social group, or setting aside a special time with a friend or family member.

Develop your plan to tackle fatigue
Several studies have found that having a broad, thorough plan can help control fatigue, even for people with severe pain. Here’s how you can develop your personal plan:

  • Record triggers or causes of your fatigue in a daily diary.
    • Find what triggers your fatigue: record your daily level of fatigue and what you did that day (activities, changes in your routine, activities that were stressful, etc.)
    • Include a food and beverage log: Note when you drink caffeinated beverages or alcohol,  when you eat dinner (a heavy or light meal?), when you drink fluids, and other related information.
    • Record when you exercise and nap: length of time and how long before bedtime.
    • Keep a record (log or diary) of when you start a new food or activity or make a change to your diet or schedule. An accurate day-to-day log will be an invaluable tool for you and your doctor to use to identify triggers that interfere with your sleep and increase your fatigue.
  • Once you have identified possible triggers, change one thing at a time to see if the change helps your fatigue.
    • For example, if you normally have coffee after dinner, skip that for a couple of days and see if it makes a difference.
    • It’s important to change only one thing at a time. That way you can identify if what you changed is causing the problem.
    • Sometimes even small changes can make a huge difference.
  • Make changes to your routine/diet based on what you learn from the keeping your daily log. Make these changes part of your daily routine and stick to the new plan.
  • In the end, your plan should include following the steps above to help improve your fatigue level. For example, identify your triggers so that you can avoid things that interfere with your sleep and learn new strategies to reduce stress.

Focus on you 

  • Take control by accepting what you can and cannot do, set your priorities, and focus on what’s important in your life.
  • Establish boundaries and let friends, family, and coworkers know what you need.
  • Self-reflection: Think about the challenges that are hardest and most draining for you and explore ways to make dealing with them easier.

Make the most of your healthcare team 

  • Avoid unnecessary medications that can cause fatigue. Ask your doctor and/or pharmacist to review all the drugs you take, including herbal supplements and over-the-counter drugs, for possible side effects involving sleep and/or fatigue. Explore the possibility of eliminating those drugs and/ or replacing them with other medications that have less effect on sleep or fatigue.
  • Talk to your doctor(s). If fatigue is a big problem for you, let your doctors know about it. Doctors and other health care providers solve problems in different ways, so if one is not able to help you, ask for a referral to someone who can. There may be medications and/or therapies that can ease fatigue and/or sleep problems.

Connect with family and friends

  • Did you know that when you ask others who have chronic pain for help, you are helping them at the same time?
  • Ask family and friends for help. They can be a big support if you let them know what you need.
  • Family and close friends can be keen observers of triggers that make you more tired or irritable due to fatigue and/or pain. Ask them for input.
  • Find peer support: People who are living with the same chronic condition understand the challenges and often provide compassion, support, and helpful advice and information to those on the same journey.
  • Watch the following video.
  • Find a support group near you (the American Chronic Pain Association: https://theacpa.org/support-groups)

Exercise  

  • Exercise is an important ingredient in any plan to help manage chronic pain.
  • Including regular exercise in your daily routine may reduce fatigue and help you sleep better, especially if you exercise several hours before going to bed.
  • Getting enough of the right kind of physical activity can also help you stay sharp and focused.
  • Even if you have difficulty standing or walking, you can still exercise by following routines designed to be done while sitting in a chair (including chair-based yoga).
  • A physical or occupational therapist can help design an exercise plan that works for you.
  • It’s a good idea to talk with your doctor about your exercise program to make sure it is safe for you.

Patient stories, tips and tricks for combating fatigue 
Belinda’s story:

Fatigue, ugh, my constant companion! Fatigue and I have known each other for a long time and I finally have it under control!! It took lots of time to be able to live with my fatigue but I have found a way that works for me.

First and foremost, I had to get to know what triggered my worst fatigue. This happened after lots of trial and error and thinking hard about what made my fatigue worse on certain days. Different triggers or multiple triggers on one day were the problem.

How did I figure this out? At night when I couldn’t sleep, I would mentally go back through my day and figure out what was different from the day before when I had less fatigue and could fall asleep better.

My triggers include exercising too late in the day, doing too much housework at one time, going on too many errands in one day, stress from family situations, side effects from some of my medications and poor sleep habits.

        Belinda’s tips to reduce fatigue

  • Include regular exercise in your daily routine, but not within 2 hours of bedtime.
  • Remember to take breaks and pace yourself so you don’t overdo or get overheated. Talk to you doctor before starting any exercise program.
  •  Think about what interferes with your sleep and try to eliminate it.
  • Avoid drinking caffeine or alcohol, which can disturb your sleep cycle, before bedtime.
  • Turn off your computer and avoid your phone screen a few hours before going to sleep.
  • Drink a calming herbal tea or try a calming activity to help you unwind before bed.
  • Before bedtime, avoid caffeine, alcohol, or a large meal.
  • Set a cut-off time for eating and drinking.
  • Identify sources of stress that you can change or avoid.
  • Avoid stressful situations—like watching an upsetting movie or looking at FacebookTM.
  • You may benefit from psychotherapy to help you identify ways to reduce your stress.
  • Do things during the day that help you relax or bring you joy.