Like many people, we can think that low back pain is the evil of the century, and we could be dreadfully mistaken – judging just by my experience.

It seems that new evils have crept into society. I’ll discuss them below.

Not a day goes by (and I am not abusing the formula for the article) without five to six people mentioning disabling fatigue. That’s unlikely to help people evolve!

Just yesterday, I heard this request innumerable times. A simple calculation revealed that 46% of my consultations of the day had at least this reason.

Most often, it is described using the following formula:

• “I don’t know why I am tired.”

Regularly, this fatigue is also mixed with the concept of chronic pain! The latter is often described as an ill-defined, diffuse pain, taking on a fleeting character. The formula:

• “It hurts all over, and nothing works” is the most common expression.

A third point that can be defined as both the cause or the consequence of the previous two, depending on the case, is a form of weariness. The associating sensations are loss of energy, lack of desire, loss or lack of motivation, and a persistent feeling of emptiness. There is also a formula:

• “I don’t feel good; I don’t know why I don’t know what is happening to me”,

Generally, fatigue is a mild symptom; the etiologic diagnosis is simple, and the resolution is quick with the appropriate management. We will see shortly that this fatigue is often described as an incomprehensible and slyly destructive illness that responds to simple mechanisms. Luckily, the solutions are just as easy to understand as to implement.

However, there are cases where fatigue ( and pain ) results from more severe pathologies, which should not be ignored. Some are rare, complex, and difficult to diagnose, even for the most seasoned therapists.

When fatigue becomes chronic (several months) and unexplained, further investigation is needed to obtain an accurate diagnosis. Scientists are not unanimous on this chronicity’s mechanisms, origins, or causes. Therefore, it is very challenging to identify the necessary solutions.

That’s a perfect loophole for vitamins and other food supplements. They promise to shape and energise in just one or two months. Thus, however flawed, these magical pills offer a straightforward and quick solution where the scientific community stammers its science!

I will take you on a journey through the current knowledge on the subject to explore various rare diagnostic avenues.

Chronic pain and fatigue are more frequent symptoms than we imagine. For example, in an English study, a third of Brits have already experienced the feeling of fatigue. Up to 5% are fibromyalgia patients. In the United States, a large study found that approximately two million Americans suffered from chronic fatigue.

Even if the enigma of the origin of these pathologies remains unresolved, scientific studies are beginning to identify various elements. The great difficulty is the intimate interconnection between the pathologies. This issue complicates the diagnosis and, in fact, the management – as you will see below, there are solutions.

Pathologies to Understand

Let’s start with a relatively poorly understood condition:

Myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS)

This controversial, complex pathology is a chronic condition characterized by symptom clusters, including pathological fatigue and malaise. Besides, it worsens after

• Exertion
• Cognitive dysfunction
• Immune dysfunction
• Low-quality sleep
• Pain
• Autonomic dysfunction
• Neuroendocrine and immune symptoms

The hallmark symptom is the post-exertional fatigue associated with numerous neurological, cardiovascular, respiratory, and gastrointestinal complaints. The fatigue, described by patients, is:

• Worsened by exertion and low upright posture
• Not relieved by rest, and:
• No medical reason can be found for it

We must clearly distinguish this chronic fatigue from the feeling of fatigue and lassitude mentioned above. This is a rare pathology whose mechanisms of action are highly complex. Thus, I will not detail them except for what is necessary to note the role of alterations in the immune system and oxidative stress.

Fibromyalgia (FM)

Fibromyalgia is characterized by chronic pain, fatigue, and a cluster of functional symptoms. The condition is frequently associated with the first or even confusion during the diagnosis.

It is a syndrome that does not present a well-defined underlying organic disease.

The primary driver of FM is sensitization, which includes central sensitivity syndromes generally referred to as joint stiffness, chronic pain at multiple tender points, and systemic symptoms including:

• Cognitive dysfunction
• Sleep disturbances
• Anxiety
• Fatigue
• Depressive episodes

Fibromyalgia is a pathology whose diagnosis is based solely on symptoms: biology and radiology do not add anything more. It remains controversial, and in fact, it is estimated that in 3 out of 4 cases, the diagnosis is not made correctly.

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is a pathology encountered more and more often during consultation. The connection with the intestinal microbiota was made a few years ago, and the entire scientific community now accepts the notion of the gut-brain axis.

There’s something even more interesting:

IBS appears to be connected with fibromyalgia. 70% of people with fibromyalgia have symptoms of irritable bowel syndrome.

Postural Orthostatic Tachycardia Syndrome (PoTS)

PoTS is a syndrome that accelerates the heart rate when getting up. It often causes asthenia associated with symptoms of vertigo. Anxiety is very present, further aggravating the clinical picture. This pathology and related symptoms are common in FM and ME / CFS.