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Dog Tired - Fatique

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"It seems like you're always stuck in second hasn't been your day, your week, your month, or even your year" (Theme from TV programme, ?Friends')

The fatigue experienced in arachnoiditis is not simply feeling a bit tired, it is feeling as if someone pulled the plug and let all our energy drain out. It is not just feeling sleepy, but a feeling of having no strength left to do anything.

It is in essence very similar to the fatigue felt in other chronic conditions, notably MS, chronic fatigue syndrome (CFS), Post-polio syndrome and autoimmune conditions such as Rheumatoid arthritis and Systemic Lupus.

How doctors describe fatigue:

Fatigue: the tiredness felt by normal individuals after vigorous exercise or prolonged intellectual work with normal sleep/wake cycles; relieved by restful sleep, it is not a symptom

Malaise: from the French word for ?not feeling well'. A non-specific term.

Asthenia: pathological fatigue: i.e. associated with illness

As you can see, doctors use the term ?fatigue' in a somewhat different sense to how patients use it.

Fatigue as experienced by people with chronic illnesses such as arachnoiditis is more pervasive than simple ?tiredness'.

How fatigue affects us:

  • Tiredness
  • Weakness
  • Lack of energy  

In the population as a whole, fatigue is 3 times more common in women of childbearing age. In young women, it is often a symptom of anaemia or pregnancy. In older people it is more commonly associated with circulatory problems or medication.


Common predisposing factors for attacks of fatigue include:

  • Overdoing things
  • Worry and stress
  • Not keeping up with helpful strategies such as massage
  • Stimulants: caffeine, sugar
  • Diet high in processed foods
  • Heat: e.g. hot bath

Why does fatigue occur?

There are a number of reasons why people with chronic illness such as arachnoiditis experience fatigue. These include:

  • Medication: sedating properties of some painkillers, especially if related to morphine; also antidepressants such as amitriptyline may cause daytime sleepiness as may long-acting sleeping pills
  • Pain: interferes with the sleep/wake cycle, disrupts appetite and causes immobility
  • Depression: loss of energy

What are the consequences of fatigue?

  • Decreased activity, which may lead to loss of muscle tone and strength. Structural and functional changes in muscles have been noted in persisting fatigue states
  • Impaired thinking ability with reduced attention span
  • Disrupted sleep/wake cycle; insomnia

The way in which fatigue may impact on your life commonly includes the following problems:

  • Difficulty with everyday chores, even small ones
  • Feeling of no energy, feeling drained
  • Feeling of having no strength to do anything
  • Having trouble thinking, making decisions, remembering things
  • Breathlessness after light activity
  • Dizziness or light-headedness
  • Difficulty in sleeping
  • Loss of sex drive
  • Feeling more emotional than usual
  • Cutting down on social activities which can lead to feeling isolated

Fatigue is both a physical and a mental symptom. It is highly variable from one person to the next.

It can show itself immediately after the triggering event (such as overdoing things) or can be delayed by a couple of days. It may also be accompanied by other symptoms such as increased pain, flu' type feeling, joint pains etc.

Like the fatigue of MS, that of arachnoiditis often doesn't go away after one night's rest. Generally it may take two or three days of rest to recover.

Similarly, fatigue can be cumulative. One busy day may not be too much, but two or three in a row can be too taxing and lead to a bout of fatigue.

Chronic symptoms of pain, muscle spasms etc. are all likely to be worse during these periods of fatigue. Also, mood may be low, and like anyone really tired, we tend to be more anxious, more irritable and emotional, and have difficulty thinking straight.

You may find that certain times of day are worse than others. Often mid-afternoon is a low point because of the hormone levels (it is the same for healthy people, but much less of a problem).

Going outside into the garden for some fresh air and bright light may help to banish unwanted sleepiness (one aspect of fatigue), or if necessary, a short nap can be taken (but if you are having problems with insomnia, this may be unwise).

You might discover that you are most fatigued when you haven't eaten for a few hours (more than three or four).

This might be accompanied by feeling anxious, sweaty, headachy and generally unwell. It might be linked to a low blood sugar, especially if you had a high sugar meal before, which might have led your body to over-compensate.

Try to avoid high sugar intake and opt instead for a more balanced carbohydrate intake, which allows a steadier blood sugar.

Similarly, if you drink a lot of coffee, you may be energised until the effect wears off, at which point you may feel rather drained. Drinking more coffee to counter this will only start the whole process off again.

In arachnoiditis, as in MS, many people have trouble coping with hot conditions, and may find that heat, such as in a hot bath, makes their symptoms generally worse and in particular exacerbates fatigue.

Avoidance of hot situations and strategies for cooling may help to ensure that this is not a trigger for episodes of excessive weariness.  

Secondary problems:

Our family and friends may not realise the depth of this fatigue, and the way in which it can come upon us suddenly and be overwhelming. They may equate it to how they feel when they are tired, but it is in fact qualitatively quite different.

However, we can end up being thought of as lazy or trying to get out of activities unless the extent of the problem is realised. It is therefore important for family members (and friends) to learn about this aspect of arachnoiditis in order for recriminations, arguments and misunderstandings, which can seriously undermine relationships, to be avoided.

Other conditions in which fatigue is common:
  • Chronic Fatigue Syndrome
  • Multiple sclerosis
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Lung disease
  • Cardiovascular disease
  • Cancer
  • Depression
  • Insomnia
  • Early and late pregnancy
  • Anaemia
  • Diabetes
  • Viral illness
  • Thyroid disease (hypothyroidism)
  • Medication: especially multiple