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Polyneuropathy and fatigue
FATIGUE IN POLYNEURPATHY IS COMMON BUT NOT commonly KNOWN
Many people who suffer from polyneuropathy also suffer from exhaustion and fatigue. Most people are not aware that their tiredness is related to the nerve damage and this connection is rarely adressed. If you suffer from fatigue due to polyneuropathy, you will certainly be interested in knowing what the causes are and what can be done about it.
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In this article I am goint to summarise the most common reasons for fatigue in polyneuropathy and the recommendations to improve fatigue that were given in several scientific studies.
SUMMARY OF THE CAUSES OF FATIGUE IN POLYNEUROPATHY
There are many causes of exhaustion in polyneuropathy. Often several factors play a role at the same time. The most important of these are:
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Sleep problems
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Depression
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Muscular overload
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Physical inactivity
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Side effects of medication
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You can read a recent study on this here: Lawley et al. (2020)
MULTIPLE CAUSES
With a disease as complex as polyneuropathy, there are no simple answers. The disease causes many different problems, which in turn can affect fatigue. Therefore, there is not one single cause of fatigue and exhaustion in polyneuropathy, but many that interact. Each patient has different factors at play and each person needs individually tailored measures to in order to improve. However, there are some factors that frequently occur and should be taken into consideration most of the times.
1. SLEEPING PROBLEMS
Since many patients have pain and discomfort due to polyneuropathy, they sleep poorly. What makes this worse is, that the symptoms often worsen or are felt more strongly at night. For example, one of my patients told me that she has been waking up every morning at 4:30 a.m. for years because her heels start to hurt. And this is the case even though she does not have pain there during the rest of the day.
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It is obvious that you do not sleep as good if you are in pain. Therefore, if you suffer from exhaustion, it is especially important to get suitable painkillers or other treatment for your pain. If your symptoms are worse at night than during the day, it might be a good idea to take painkillers only before going to bed.
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I know that there are many people with polyneuropathy for whom painkillers do not work. In such cases, you can ask your doctor if sleeping pills make sense for you.
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There are also other methods that can reduce pain besides medication. You can find a detailed guide to these in the following article: Why does polyneuropathy cause pain?
2. sAD MOODS AND DEPRESSION
Those who suffer from polyneuropathy sometimes have good reasons to be sad. Your mental wellbeing is a factor that can strongly influence your fatigue and feelings of tiredness, however.
Those who suffer from sadness or even depression often also feel exhausted. Pronounced daytime fatigue is even a criteria for the diagnosis of depression. Therefore, if you have symptoms of exhaustion and polneuropathy, you should also be careful not to fall into a depressed mood. Of course, this is easy to say, as no one likes to be sad and everyone would like to feel better. In order to be able to provide helpful information on self-help for depression, I spoke with Dr. Adrian Schweinoch, a psychiatrist at a clinic in Neuss, Germany.
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Dr. Schweinoch gave me several tips that may improve depression: "It is important not to withdraw too much, especially not over a long period of time. This can lead to a vicious circle of depression, which means that your mood is negatively affected by being alone and as a result you withdraw even more. The important thing is to stay active, even if this sometimes seems difficult!"
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According to Dr Schweinoch, being arround other people is particularly important. He sais:
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"If you are sitting at home by yourself, problems - including the symptoms of polyneuropathy - take up much more space and attention in your life, than if you try to focus on positive experiences and activities."
Furthermore, Dr Schweinoch stresses the importance of physical activity:
"Lack of exercise can have a significant impact on one's mood and thus can contribute to depression, which is why sports and exercise therapy and the motivation to exercise regularly play an important role in the treatment of depression!"
3. OVERSTRAINED MUSCLES
Everyone knows that you feel exhausted after you have done a lot of physical work. It is not so obvious though, that people with polyneuropathy are often doing hard physical work all the time - often without realizing it.
With polyneuropathy, your muscles' strength often decreases because the damaged nerves can no longer activate all the muscle fibres the way they used to. This means that the fewer muscle fibres that can still be activated have to do all the work. So these parts of the muscles are doing hard exercise, even in every day life. Accordingly, these muscle fibres become overworked more quickly than those of a person who does not have polyneuropathy.
In addition, the movement patterns change due to the disease. You can not walk as easily and efficiently as before and you start using slightliy different ways to move in order to compensate for the loss in strength and control. This can make moving, especially walking more straining for your body.
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If I examine the muscles of my patients, I often find that they are overloaded. This is particularly noticeable because the muscles are tight and shortened and they hurt if you squeeze them. This is very common in the lower leg and feet. However, the patients themselves often do not notice this, because their perception of these parts of their bodies is impaired due to the polyneuropathy. However, their body does notice the constant strain and reports it to you in the form of exhaustion.
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This is the reason why those who have stronger muscles suffer less from fatigue.
In two studies done with polneuropathy patients by the University of Birmingham and the University Clinic of Rotterdam this has even been proven statistically. People with stronger muscles reported less fatigue than people with weaker muslces.
You can read the studies here: Lawley et al. (2020), Bussmann et al. (2007).
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So in order to improve or prevent fatigue, you should try to take good care of your muscles. There are several things you can do for them.
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1. Strengthening the muscles with very targeted exercises, especially for the feet, lower legs and hands.
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2. Train your coordination and balance to make your movements more efficient and less energy consuming. You can find exercises for this here: Exercise for polyneuropathy
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3. Actively relax your muscles with massage and stretching.
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4. PHYSICAL INACTIVITY
Another significant contributor to fatigue, according to scientific studies, is physical inactivity. Those who exercise a lot at a healthy level also report fewer symptoms of fatigue. On the other hand, those who are inactive also suffer more from fatigue. This has been known in sports science for a long time. In fact, there were already studies decades ago that showed that physical activity can improve chronic fatigue. This has also been investigated among those with polyneuropathy who suffer from fatigue.
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A study at the University Hospital of Rotterdam investigated whether fatigue would improve in patients with chronic inflammatory polyneuropathy if they participated in an exercise program. 20 patients exercised for 45min three per week on exercise bikes. After the12 weeks, the patients reported 20% less fatigue than before the training period. You can read the study from the journal Neurology here: Garssen et al. (2004)
Of course, it is not as easy for people with polyneuropathy to be physically active as it is for healthy people. You can find detailed information about training methods and which sports are recommended here:
5. SIDE EFFECTS OF MEDICation
Painkillers used by people with polyneuropathy can often cause fatigue and drowsiness as side effects. Pregabalin for example, a very commonly used drug for polyneuropathy, has been reported to cause these symptoms in up to 10% of patients.
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In addition, drug interactions can also cause similar symptoms. One of my patients reported severe problems with fatigue, drowsiness, and dizziness. She also fell repeatedly and injured herself. During a hospital stay after a fall, her medication dosage was significantly reduced and fatigue and dizziness disappeared. If you suffer from fatigue or dizziness and are taking painkillers, you should talk to your doctor about this.
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With medication, especially painkillers, it is important to check, if the negative side effects outweigh the benefits. This is not an easy decision and is different for each individual patient.
A FEW STARTING POINTS
As you can see, there are some starting points for doing something about fatigue and exhaustion. However, there is no one size fits all remedy that helps all patients in the same way.
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It is important not to resign oneself to one's fate and simply accept fatigue as a part of your life. As you can see, there are some ways to help yourself. However, if you suffer from fatigue and exhaustion, you should also talk to your doctor about it.
Christian Bitzer
M.A. Sports Science
Exercise Therapist
Owner of Bitzer Training
Email: Bitzertraining@gmail.com