Tiredness, fatigue and exhaustion: all the same or manifestations of a continuum?—Food for thought, 2022, Matti et al

Abstract

Owing to the COVID-19 pandemic and the associated post-COVID syndrome, the concept “fatigue” has gained significant importance. However, both the definition and the causes of fatigue differ depending on the disease pattern in question. Moreover, individuals who describe their symptoms in everyday clinical settings seem almost universally to use the terms tiredness, fatigue and exhaustion synonymously. In 2007, Olson described these three terms as being distinct states in her view, but that they can be placed in relation to each other on a continuum. Taking up this consideration, an overview of current research is provided. For this purpose, the published literature of the last 2 years was searched for the terms “tiredness”, “fatigue” and “exhaustion”. Some common diagnostic instruments can be found. However, the great variety of instruments used to capture the three terms is striking. Despite these different diagnostic and definition possibilities, different therapeutic measures can be derived for each of the three symptoms. It is crucial, especially with regard to further therapy, to separate the three terms tiredness, fatigue and exhaustion from each other and to consider each of them separately on the common continuum. This is the only way to establish both an accurate diagnosis and the successful individual therapy that goes along with it.

Open access, but only abstract is in English, the rest of the paper is in German, https://link.springer.com/article/10.1007/s11818-022-00372-6

 

In normal everyday conversation I would never use the word fatigue, and I don't know anyone who does. I would use "I'm tired" or "I'm exhausted", and tiredness and exhaustion are most definitely on a different scale, and tiredness is substantially less severe than exhaustion.

Doctors sometimes use words that keeps a definite "them and us" vibe to conversations. A doctor asking me if I was fatigued would be using language in a way that I don't, even though I'm perfectly well aware of what fatigue means.

 

I tell people I have 'a medical condition' which is easier for them to understand without going into details.

 

Lots of people do that. Mostly physicians, not patients. One problem with active listening and interpretation is exactly how it can lead to listening to one thing and hearing another. I don't doubt that they can't tell the difference, the profession never bothered to put some work into this. But if you don't provide a coherent basic vocabulary that people can use and make sense of, the fault is entirely yours.

This is a basic vocabulary issue that is the responsibility of medicine (by default of refusing to recognize that patients are a valuable source of information), mostly the product of distortion and manipulation to allow psychosomatic ideology to remain alive. This is why you can't have science and pseudoscience in the same place, the pseudoscience degrades everything it comes in proximity to.

No other profession deals with nonsense like this, especially self-inflicted failure. It says a lot that something as awful as the Chalder fatigue questionnaire is commonly used. Awful decisions tend to continue doing awful things until they're reversed. But right now medicine is trying to eat its pseudoscience cake while having its science cake, too. It doesn't work like that. Nothing does. You either grow up and leave immature ideas behind, or you keep failing like this. Failing us, failing millions, while being unable to recognize the scale and scope of the suffering systemic failure causes.

 

The trouble is that general populous now use the word 'fatigue' when they want a slightly more serious/impressive/medical sounding word than tired or 'knackered'. In the same way people say 'i have a migraine', when they dont know what a migraine is & think its just a bad headache. Ditto 'depressed' for sad/low, 'trauma' for something stressful & a bit upsetting, 'OCD' for 'i like things clean'...... etc etc etc

Even advertisements for skin creams now use the 'fatigue' word, to sound more impressive. "XYZ eye cream fights the signs of fatigue", as if fatigue = had a late night last night.

It drives me mental

 

I recently had to see a specialist for a medical assessment. I had to spend a long time listing my symptoms and the negative effect they had on my life.

I emphasised how horrendously unwell I felt all the time (eg, "the worst flu of your life combined with a nasty hangover"). I described carefully how any activity would cause me to feel incredibly ill (eg, "PEM feels like being poisoned").

I did not use the words "tired", "fatigued" or "exhausted" once.

He then concluded with "and of course you're fatigued too". After all my careful attempts at trying to explain my illness, he wanted to distill it all down to "fatigue"

 

I'm going to see my new GP this fall. I'm preparing myself to describe dysautonomia and having difficulty staying upright for any length of time. We'll see how that goes.

 

Some of that probably has to do with the obsession to invent disorders out of a primary symptom of, then simply deciding that all other symptoms are derived from this imagined primary symptom. The need to reduce things to simple concepts, but in the process completely removing all meaning out of those words. It's basically the real-life example of how physics textbooks will have problems like "imagine a cow as a sphere of uniform density" when teaching mechanics. Except it's made for real, the reduction is not for educational purposes, it's for ideological ones.

The biopsychosocial ideology broke medicine. Just completely broke it by mixing raw sewage with drinking water and saying it's all good as long as no one notices. Fits right in with the idea that infections are good and people should have as many as possible, except for some, no coherence required.

 

This triggers a question: do any other languages have better words to differentiate between these similar but unrelated symptoms? Does, for example, Chinese writing have different logograms for fatigued, tired, and exhausted? Hmmm, is there one for brainfog?

On I suppose a related note, I recently became sensitive to fermentable fibres. All of a sudden, they were inducing strong lethargy and brain fog, which I can't distinguish from those same ME symptoms triggered by other factors. I assume that it's the propionic acid. It's probably just an individualistic response involving metabolic pathways messed up by ME, but I did read about someone else on Phoenix Rising complaining about those symptoms from propionic acid. I think it's interesting that this one, common SCFA can, in certain circumstances, generate these symptoms.

 

Amen to that.

I wonder if we'll be seeing the same happen to "brain fog" soon - people using the term to describe standing in front of the fridge not knowing what they went there for and otherwise borrowing it until it becomes meaningless. At least OCD and migraine are clearly defined proper things so you can pull people up on it (if you can be arsed which I can't), but terms like fatigue and brain fog aren't on solid ground to start with.

I had a teacher work for me in the early 2000s who flew over from England to Germany. Whilst chatting she said "that's a bit OCD", and I was so shocked I asked her "Is that a thing people are saying in England now?" The next morning we were chatting in the classroom before the lesson when I suddenly stared furiously at a table and said "Who the bloody hell moved that tablecloth?" She meekly confessed that she had, and later in the day I noticed the tablecloth had been rearranged to exactly how it was before. I must have scared the life out of her.

 

yeah its already happening my friend uses it all the time when what she clearly (by the context) means, is that she feels a little distracted/sleepy

 

Tiredness, and exhaustion are just ways of people describing a lesser or worse feeling but neither are symptoms of disease. They are a normal state of the body that only becomes associated with disease when they happen in ways that are not those expected. Feeling dizzy when you get off a carnival ride as opposed to taking trying to stand up.

Fatigue is slightly different because it is a medical term to describe what happens as a response to illness. It never made sense to base a disease on fatigue and then equate fatigue with the normal experience of healthy bodies. It has made a real mess.

There must be a complex biological reason for the feelings of tiredness and exhaustion which come from excess work. It could be designed to save calories in a world where they are limited or it could be to repair the body before it becomes broken.

Then there is - let's call it fatigue which is a response to infection or injury and is probably a repurposing of the normal tiredness reaction. It may all be the same mechanism.

But there are also things we use the same words for but are different processes. There is a direct effect on how much we can do with heart disease or mitochondrial disease. That is when the outcome is tiredness but it is in a damaged body, not a healthy one.

So it is not important whether there is a continuum or if the words all describe the same thing but the interesting, useful questions are what is causing this feeling not matter the degree. It is the begiining of diagnosis not the end.