There could be a lot less
Many patients with a chronic illness suffer from extreme fatigue. There is more and more insight into what you can do about it.
Being so tired that you prefer to go to bed at half past ten in the morning. Not because you’ve done a lot: it seems like you’re tired of nothing. Research has shown that fatigue affects about 20 to 40 percent of the ex-cancer patients is a big problem. There are rehabilitation programs for them.
Chronically ill
Only in recent years has it become clear that extreme fatigue is not only common after cancer, but also in many chronic diseases. “At least half a million people with a chronic disease are severely tired,” says clinical psychologist Hans Knoop. He is head of the Chronic Fatigue Knowledge Center of the University Medical Center St Radboud in Nijmegen.
“In several chronic diseases, fatigue is the complaint that most affects patients.” Bee multiple sclerosis this concerns 70 percent of all patients, with diabetes 40 percent. A large group also suffers from fatigue in rheumatism and muscle diseases. Just like with cancer, this fatigue is caused by the disease itself, by the treatment or by the stress that this entails. Knoop: “There are often clearly identifiable causes of fatigue.”
fatigue
But the striking thing is that after a while there is often no longer a clear connection between the physical abnormalities that match the disease and the fatigue. Someone with rheumatism may remain extremely tired, for example, even if the inflammation that initially caused the fatigue has greatly diminished. Knoop: “In that case, the fatigue is maintained by factors other than the disease itself. Behavior and thoughts in response to the fatigue can then play an important role.”
Does this mean that the fatigue is mainly ‘between the ears’? You can’t say that like that, says Knoop. “Then it quickly seems as if you are saying that tired people are acting up, and that is certainly not the case.”
Research nevertheless shows that what you do and think is important, in addition to physical factors. An example is the belief that you will always be tired and that there is nothing you can do about it. That feeling of powerlessness can intensify fatigue.
“But also constantly fighting against it and questioning yourself and exhausting yourself can unintentionally perpetuate the fatigue,” says Knoop. “That eats up energy and means that you need a longer time to recover afterwards.” Resting too much can also cause fatigue. Button: “Many people hope that it will make them fitter, but the sleep-wake rhythm can be completely disrupted if you often go to bed during the day.”
Cause
The exact cause of the persistence of fatigue differs per person, but also per condition. For example, the fear of returning from cancer play a role in ex-cancer patients. Processing the often traumatic treatment can also lead to exhaustion. In rheumatism, there seems to be a strong association between pain, decreased activity and fatigue.
Button: “Moe is tired, many people think. But strangely enough, that is not the case. With every disease you also have to look for specific points of departure to reduce fatigue.” Research into many chronic diseases is still in its infancy, but more is now known about fatigue after cancer.
Therapies
For example, the Nijmegen Knowledge Center has developed a special therapy for tired ex-cancer patients. In this cognitive behavioral therapy, which lasts an average of six months, they learn to think and act differently. Together with a therapist, they investigate which thoughts and behavior allow the fatigue to persist. They learn to divide their activities in such a way that they do not become exhausted. Knoop: “Some people first have to take a step back. Others get out of the grip of fatigue by doing more.”
Scientific research shows that the majority of participants benefit from this therapy. They are ‘normal’ tired again and are no longer hindered in their activities by fatigue. It is not known why it does not catch on with the rest.
A similar therapy has been developed for fatigued patients with multiple sclerosis, in collaboration with the VUmc in Amsterdam. Knoop is currently also working on a treatment for tired diabetes patients.
Move more
Exercise is an important part of therapy, but not an end in itself. Hans Knoop: “Recently we have shown that reducing fatigue is not so much about getting in better shape. By exercising more, people experience that they can do more than they thought – even when they are tired.”
Patients notice that they don’t have to worry about getting even more tired. “As a result, the feeling of powerlessness decreases,” says Knoop. “In this way they regain control over their lives and they can tackle the fatigue. That means that the fatigue symptoms decrease or become manageable.”
General practitioner
General practitioner and professor of general medicine Henriëtte van der Horst of the VUmc in Amsterdam believes that general practitioners should also make use of the knowledge gathered in Nijmegen. Together with a colleague and the Dutch College of General Practitioners, she developed a training course for general practitioners: Policy for unexplained physical complaints.
Many GPs feel left empty-handed if they cannot find a physical cause for complaints such as fatigue. It is essential that they take enough time to inquire about the impact of the fatigue. Van der Horst: “Only when patients feel recognized can you proceed to the second step: discussing their thoughts about the fatigue and how they can maintain the fatigue.”
Find out yourself
Although more attention has recently been paid to fatigue after cancer or chronic diseases, there is still far from being a special therapy for everyone. This means that many patients have to figure out for themselves how to deal with their fatigue.
Sources):
- Plus Magazine
