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Chronic Pain and Fatigue: A Chronic Cycle

We all seem to have a closer relationship to fatigue these days. Let’s dig into the chronic pain and fatigue connection.

Alissa Link, MPH
Reviewed by 
Dr. Kate Smith N.D.
February 3, 2022
 min. read

Talk to anyone who’s been working from home for the last two years, and you might hear phrases like “Zoom fatigue,” “apartment fatigue,” or “takeout fatigue.” We all seem to have a closer relationship to fatigue these days than we ever did, whether the silly variety like “can ‘sweatpants fatigue’ be a thing?” or real fatigue, because we’re all overly exhausted and frustrated because of it.

But fatigue is more than a catchall for being “over it,” and if you’re one of the millions of people who live with chronic pain, you know that fatigue itself can, well, hurt. Let’s dig into the chronic pain and fatigue connection.

Fatigue vs. Being Tired 

Even though we often use the words interchangeably, there’s an ocean of difference between being tired and fatigued.

Feeling tired is natural. It’s the feeling at the end of a busy day, a high-energy exercise class, or after having laid awake all night, not being able to sleep for one reason or another, that lets you know sleep would be beneficial.

On the other hand, fatigue is consistently feeling wiped out, exhausted, low energy–both mentally and physically–and this feeling of fatigue lasts and lasts no matter how much sleep you get. It stands in the way of daily activities, work, our social lives, and ironically, it can even disturb our ability to sleep.


Some Common Causes of Fatigue

Fatigue can be triggered by lifestyle factors or health issues, and let’s not forget, is also now recognized as its own condition, chronic fatigue syndrome or myalgic encephalomyelitis (sometimes called ME/CFS).

Lifestyle factors can include short-term causes that are more easily remedied, such as:

  • Jet lag
  • Working late
  • A night or two of insomnia
  • Stressful life events, such as moving, getting a divorce, or losing a loved one
  • Over-exercising or under-exercising
  • Weight
  • Shift work where the schedule changes frequently
  • Caffeine / alcohol use 
  • Dehydration
  • Nutrient depletion

When any of these factors cause fatigue, the solution might be a simple change, like keeping a better sleep routine, eating a well balanced diet, or even letting ourselves grieve or be stressed. If work schedules are a significant factor, that might be a more formidable challenge to overcome. In that case, focus on the things that you can change. Not every schedule will accommodate regular exercise, proper nutrition, stress management, and a tight seven hours of sleep, but we can usually control part of that equation.  

Health issues that can cause fatigue range from expected conditions to some that may seem somewhat disconnected, including:

  • Flu
  • COVID-19
  • Sleep apnea
  • GERD/acid reflux
  • Hypothyroidism
  • Anemia
  • Cancer
  • Heart disease
  • Diabetes
  • Autoimmune diseases like fibromyalgia, rheumatoid arthritis, and inflammatory bowel disease
  • Anxiety
  • Chronic pain

Some of our  best tools for treating fatigue associated with the above conditions are similar to the lifestyle remedies–make your food your medicine, sleep as well as you can, get regular exercise, and find ways to manage stress.

But there are some other things to keep in mind. Speak with your doctor about whether any medications–statins, antidepressants, steroids, or antihistamines–might be causing more fatigue. Fatigue might also be an underlying symptom of something as yet undiagnosed, like a hormonal imbalance, high blood pressure, or anemia. So it’s always best to keep your healthcare team in the loop when experiencing fatigue for more than a month.

How are Fatigue and Pain Related?

When living with chronic pain, fatigue seems to go hand-in-hand with the pain itself. But does chronic pain cause fatigue? Can a person be exhausted from pain?

The short answers are “yes” and “yes.” Chronic pain often translates into sleepless or restless nights because the pain itself doesn’t turn off, thus keeping us from proper restorative sleep. As we’ve discussed, if we’re not sleeping well over and over again, our bodies get worn down, and fatigue can set in. So it’s critical to try and get on the right track, aiming to get as much restful sleep as we can. The goal is at least seven hours every night.

When we’re dealing with chronic pain, it’s common to put off or stop exercising altogether. A lack of exercise may seem completely incongruent with feeling fatigued; where do we find the energy for a yoga class when we can barely get out of bed? But frequent inactivity leads to a loss of muscle mass, making fatigue worse. Think about it: If we don’t use our muscles much when we want to use them for even a minor exertion–going for a walk with the grandkids–it requires much more work to perform the activity.  Engaging in a regular exercise routine also helps to balance stress hormones and improve mood.  In a study of people with fibromyalgia, researchers found that folks who spent more time doing light physical activity felt lower pain and fatigue levels than those who were completely inactive. 

Eating a well balanced diet can be incredibly challenging for people living with chronic pain and exhaustion. Some days, the thought of preparing a healthy meal or two can seem entirely out of the realm of possibility, so takeout or a drive-thru becomes a go-to. Sure, these are convenient and easy options, but they’re not generally the healthiest options. In addition to proper nutrition, our bodies need hydration  and lots of vitamins, minerals, and other nutrients we’re not going to find on most menus. An unbalanced dietor not drinking enough water can add to chronic pain and fatigue.  (I think staying away from labeling a diet as “bad” or “good” can be more empowering for readers. It can be so easy for patients to feel shame around their food choices, and I have found using different languaging around diet can be helpful and encouraging: ) 

Inflammation and pain itself are both factors that can lead to, or worsen, fatigue. In chronic pain conditions, inflammation happens when proteins called cytokines congregate in inflamed areas in our bodies. The cytokines tell our bodies to increase blood flow to the site to repair tissues or wounds or sweep out a virus or bacteria. But they’re also associated with increased pain and fatigue. So when chronic pain is associated with  persistent inflammation, it also means persistent fatigue.

Challenging  emotions like stress, anxiety, and depression, as we know, can wreak a lot of havoc on a body with chronic pain. These emotions trigger the production of certain hormones, like cortisol (the “fight or flight” response), adrenaline, and oxytocin (which intensifies both happy and sad emotions). When we feel regular or constant stress, anxiety, or depression, our bodies simply wear themselves out from feeling like they’re in perpetual danger. This, again, means more pain and fatigue.

Chronic pain and fatigue are so often paired together, 3 out of 4 people living with chronic pain report being fatigued. And as many as 94% of people with chronic fatigue syndromes report muscle pain.

How to Live with Chronic Pain and Fatigue

Get some rest! While good sleep is essential for everyone, it’s crucial for those of us living with chronic pain and fatigue. Sleep is the time when our bodies repair themselves, and for some, maybe the only time our bodies and brains fully relax, turning off all the pain and anxiety signals.

Improving sleep quality can sound like a daunting task. But break it down into small steps that make it easier to achieve. Set a routine to go to bed and get up around the same times every day. Work toward that new bedtime by eating lighter meals earlier in the evening, and include sleep-promoting foods like kiwi and salmon. Swap a vigorous evening workout for a relaxing after-dinner walk, and skip the caffeine and alcohol altogether. 

Turn off devices before turning out the lights. Maybe write down something to be grateful for that day. Try meditating, gentle yoga, or a hobby like crocheting or reading to wind down. The key is to quiet our brains and put ourselves in a positive mood for rest.

Eat the rainbow! Proper nutrition and hydration are the cornerstones of a healthy life. hile it can be hard to muster the energy to cook while dealing with fatigue and chronic pain, the better we eat, the better we feel.

On a relatively good day, take an hour to prep a few meal components that can be quickly cooked or reheated throughout the week. Cook lentils or otherbeans and use them in soup, salad or make them into patties. Wash and de-stem a bunch of dark, leafy greens to saute or throw into a simple, comforting soup or stir fry. Throw a few sweet potatoes in the oven, and chop a couple of red onions for all kinds of delicious dishes. Just that little bit of prep work makes eating healthy more realistic, even on bad days.  

Aim to eat regular meals rich in fiber, healthy fats and lean protein to help balance blood sugar and stabilize stress hormones. Limit caffeine and alcohol intake. 

Eat an anti-inflammatory diet: Fill your diet with foods that help to reduce inflammation including lots of veggies, berries, nuts and seeds, legumes, fish, whole grains, and herbs such as ginger and turmeric. Reduce foods that increase inflammation such as refined carbohydrates, sugar, highly processed vegetable oils and trans-fats, dairy products, red meat and pork. 

Keep moving! Yep, even when it’s an especially painful day. In a recent blog post, we learned that distracting ourselves with podcasts, music, TV, or conversations with an exercise buddy can help make the activity feel physically easier. Other research has found that even elite athletes hit mental fatigue walls long before reaching physical exhaustion. Or, as the lead scientist, Samuele Marcora, puts it, “​​most of us can keep going after our brains start telling us to stop.”

This research found that we can train our brains to manage fatigue, basically through positive stimulation. Instead of focusing on how exhausted we are, focusing on positive things can make activities seem like less effort. In the research, 5-second bursts of vigorous exercise bookended less strenuous periods, often called interval training. And just about everyone can do anything for 5 seconds, right?

Manage emotions! Dealing with chronic pain and fatigue can often mean feeling overwhelmed and helpless. It’s extra important to learn to deal with challenging emotions like stress, fear, anxiety, and depression. Channel them into exercise. Practice hobbies, like sketching or playing piano, or techniques like deep breathing or meditation that can help ease challenging emotions. 

If these don’t help, seeking professional assistance shows huge courage and determination. Speak with your primary care physician about medications that can help alleviate overwhelmed feelings. Or go the medication-free way and speak with a talk therapist or cognitive behavioral therapy specialist because we can all use a little help with our mindsets from time to time.
Don’t do it alone! Living with chronic pain can be isolating, even when we’re surrounded by people who love us. A Lin Health Coach offers the empathy, encouragement, and advice you so deserve. By signing up today, you can take the first step toward pain and fatigue relief.

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