how to deal with fatigue saul berkovitz mrcp, mcpp, mfhom consultant physician, chronic fatigue...
TRANSCRIPT
![Page 1: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/1.jpg)
How to deal with fatigue
Saul Berkovitz MRCP, MCPP, MFHomConsultant Physician, Chronic Fatigue ServiceRoyal London Hospital for Integrated Medicine University College London Hospital NHS Trust
![Page 2: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/2.jpg)
“Everyday” fatigue
• A normal sensation experienced by everyone
• Exhaustion or tiredness (physical or mental)
• Temporary and relieved by rest
• Different from:– Weakness– Shortness of breath– Effort intolerance– Sleepiness– loss of motivation and pleasure
![Page 3: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/3.jpg)
Fatigue in the population
• Main complaint in 5-10% of GP consultations
–an important factor in another 5-10%
• ‘TATT’
• Half of patients are still fatigued 6 months later
![Page 4: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/4.jpg)
Medically significant fatigue
• Persistent or relapsing fatigue
• Lasting several months
• Not the result of over-exertion
• Not relieved by rest or sleep
• Causing substantial impact / disability
![Page 5: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/5.jpg)
Associated symptoms
• sore throat
• tender lymph glands
• muscle pains
• joint pains
• new headaches
• unrefreshing sleep
• post-exertional malaise
• poor memory or concentration
![Page 6: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/6.jpg)
Maintaining factors
• Older age
• Mood disorders
• Illness beliefs
• Inactivity
• Sleep problems
• Search for legitimacy, benefits, diagnostic label
![Page 7: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/7.jpg)
Cancer-related fatigue
• Variety of cancers
• Before diagnosis (40%)
• During treatment (80-90%)
• Beyond treatment completion (33% at one year)
• High impact (more than pain, depression, nausea)
![Page 8: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/8.jpg)
![Page 9: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/9.jpg)
Possible mechanisms of fatigue
• Alteration in serotonin (“happy hormone”)
• Alterations in cortisol (“stress hormone”)
• Alterations in circadian rhythm (“biological clock”)
• Alterations in muscle metabolism
![Page 10: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/10.jpg)
![Page 11: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/11.jpg)
Approach to management
• “Biopsychosocial” rather than “biomedical”
• A definite diagnosis
• Over-investigation vs. under-investigation
• Empathy
• Non-judgemental style
• Commitment to continued care if required
• Associated anxiety & depression
![Page 12: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/12.jpg)
Management – drug treatment
• Anaemia (epoetin alpha)
• Antidepressants
• Night time sedation (amitriptyline)
• Corticosteroids
• Psychostimulant (methylphenidate (Ritalin))
• Wakefulness enhancer (modafinil)
• Metabolic enhancer (L-Carnitine)
![Page 13: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/13.jpg)
Management – non-drug treatment
• Self-management
• Professional management– Multidisciplinary; integrated; group or individual
• Activity management therapy
• Graded exercise therapy (GET)
• Cognitive behavioural therapy (CBT)
![Page 14: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/14.jpg)
Activity Management Therapy
![Page 15: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/15.jpg)
Activity management therapy
• Pacing advice
• Activity diaries and scheduling
• Energy conservation
• Stress management + relaxation training
• Management of sleep problems
• Longer term target setting
• Coping with setbacks
![Page 16: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/16.jpg)
![Page 17: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/17.jpg)
Graded exercise therapy
![Page 18: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/18.jpg)
Graded exercise therapy
• Appropriate exercise is safe and beneficial in fatigue
• Gradually progressed exercise programme starting from an individualised baseline
• Assessment
• Aerobic exercise, strength training, core stability training and stretching
• Gym / home
• Short- and long-term goal setting
![Page 19: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/19.jpg)
Cognitive Behavioural Therapy
![Page 20: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/20.jpg)
Cognitive behavioural therapy
• How thoughts and feelings influence behaviour (and affect health and well-being)
• Aims to promote self-management
• Short-term
• Collaborative
• Problem-solving
• Goal-focused
• Individual or group
![Page 21: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/21.jpg)
Cognitive behavioural therapy
• Unhelpful beliefs / thoughts about illness
– “Activity makes me feel worse, so it will damage me”
– “I can’t do X as well / often as I used to so I won’t do it any more”
– “I can’t do X any more so I’m a failure”
• Guilt / denial / embarrassment
• Overestimating threats (catastrophising)
– “I might collapse in the street so I won’t risk going out”
• Over-vigilance of symptoms
• Shift away from the pursuit of cause
• Functioning the best we can within our constraints
![Page 22: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/22.jpg)
Self-management
Pacing
Graded exercise
Stress and mood management
Fatigue services:
www.afme.org.uk/me_cfsDirectorySearch.asp
Books: “Fighting Fatigue: Managing the Symptoms of
CFS/ME” by Sue Pemberton
Computerised CBT: www.fatiguefighter.org.uk
![Page 23: How to deal with fatigue Saul Berkovitz MRCP, MCPP, MFHom Consultant Physician, Chronic Fatigue Service Royal London Hospital for Integrated Medicine University](https://reader036.vdocuments.site/reader036/viewer/2022062421/56649e4e5503460f94b44874/html5/thumbnails/23.jpg)
Acknowledgements
• Chronic Fatigue Team, Royal London Hospital for Integrated Medicine
• Chris Perrin (Nurse Specialist)
• Mary Queally (Occupational Therapist)
• Margaret Hooper / Raj Sharma (Psychologists)
• Esther Odetunde (Physiotherapist)
• Sue Thurgood (Dietician)