Thiếu máu B12 thiếu hụt ung thư mạch máu não Hóa trị bệnh mãn tính mệt mỏi hội chứng tắc nghẽn mãn tính Bệnh phổi Cushings hội chứng Deconditioning bệnh tiểu đường Dysthymia Fibromyalgia nhiễm HIV Suy giáp Lyme trầm cảm | 300 Christodoulou et al. Table 2 Medical Conditions Commonly Associated With Fatigue Anemia Anxiety disorder B12 deficiency Cancer Cerebrovascular disease Chemotherapy Chronic fatigue syndrome Chronic obstructive pulmonary disease Cushings syndrome Deconditioning Diabetes Dysthymia Fibromyalgia HIV infection Hypothyroidism Lyme disease Major depression Mixed connective tissue disease Multiple sclerosis Myasthenis gravis Obstructive sleep apnea and other sleep disorders Parkinson s disease Postoperative states Post-polio syndrome Pregnancy Rheumatoid arthritis Somatization disorder Systematic lupus erythematosus Viral illness As with any workup the clinician should use his or her best judgment in the workup for fatigue ordering appropriate laboratory tests and specialized testing when indicated. THERAPY FOR FATIGUE A management algorithm for fatigue is shown in Fig. 1. The clinician should first seek to eliminate or reduce factors that may contribute to fatigue including mood disturbance sleep disruption and medications that may produce fatigue as a side effect. If fatigue persists more specific interventions must be considered. These may include nonpharmacological and pharmacological interventions or a combination of both. Nonpharmacological Approaches to the Treatment of Fatigue Nonpharmacological interventions to improve fatigue in MS include education and reassurance exercise programs nutritional improvements and energy-conservation strategies. Each has at least some empirical support but all share common sense features that make them palatable to patients who might be reluctant to add another medication to their regimen. Education Fatigue in chronic illness differs from the fatigue that healthy individuals experience on occasion. The fatigue experienced by persons with post-polio syndrome PD or MS differs from that of friends Fatigue 301 Table 3 Medications That Can Produce Fatigue as an Adverse Event Drug Used for Examples Analgesics Pain control Butalbital .
