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Fatigue

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Fatigue is a state of being without energy for a prolonged period. It is often used in two distinct ways. In common life, it refers to normal tiredness after activity. In medicine, fatigue is a symptom of various health conditions. It is a complex, multi-dimensional phenomenon. It affects the body's biological, cognitive, motivational, and emotional states. This can significantly impair a person's ability to function in their normal capacity.

There are different ways to classify how fatigue presents. Physical fatigue results from muscle fatigue after intense activity. Mental fatigue follows prolonged cognitive activity. This can impair a person's ability to think or pay attention. It may also manifest as sleepiness or lethargy. Sleepiness is specifically the tendency to fall asleep. Fatigue, however, is an overwhelming sense of exhaustion. While they often coexist due to sleep deprivation, they are not the same. Fatigue is generally a longer-term condition than sleepiness.

Medical fatigue has several distinguishing features. It is often unpredictable and varies in severity. It can be profound and have an extensive impact on daily living. Unlike normal tiredness, it often does not improve with rest. Some forms of fatigue show post-exertional malaise. This is a common feature in ME/CFS and Long Covid. Other types are affected by temperature changes. For example, MS fatigue can change with heat or cold. Some conditions cause flare-ups and remissions. Lupus and fibromyalgia may have flare-ups lasting a few weeks.

The timing of fatigue can also vary between different conditions. Some types, like cancer-related fatigue or rheumatoid arthritis, may be continual. Others, such as MS or Sjögren's syndrome, vary throughout the day. A 2010 study showed different patterns for these two. Sjögren's patients reported fatigue after rising, improved in mid-morning, and worsened later. Lupus patients reported lower fatigue after rising, which then increased through the day. Some people describe a physical sensation of weight. They may feel as if lead weights are attached to their limbs.

Many factors can cause or maintain fatigue. Adverse life events and sleep disturbances are common factors. Digital screen use can cause computer vision syndrome. This leads to eye fatigue, headaches, and neck or back pain. Medications can also be a cause. This includes beta blockers, certain allergy medicines, and chemotherapy. Substance use is also linked to fatigue. A 2020 Norway study found 69% of substance use disorder patients had severe fatigue. Alcohol consumption also shows a strong correlation with overall fatigue.

Fatigue is associated with many medical categories. It is a symptom in autoimmune diseases like lupus and multiple sclerosis. It appears in blood disorders such as anemia. It is also linked to endocrine diseases like diabetes and hypothyroidism. Many infectious diseases, including COVID-19 and tuberculosis, cause it. Neurological disorders like Parkinson's disease and narcolepsy are also connected. Even nutritional deficiencies in iron or vitamin B12 can lead to it. The World Health Organization uses the ICD-11 to classify these. Fatigue is categorized under the code MG22.

Scientists are still investigating the exact biological mechanisms. One major theory involves inflammation. Inflammation can distort neural chemistry and brain function. This is known as neuroinflammation. Cytokines are small proteins that modulate immune responses. They may play a causal role in fatigue. Another theory involves reduced brain connectivity. This refers to how different brain regions communicate. Studies have found correlations in people with MS and brain injuries. Research focuses on areas like the thalamus and the middle frontal cortex.

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