DR MARTIN SCURR: Is severe tiredness ‘chronic fatigue’ or something else?

My daughter, now 40, had a traumatic birth six years ago – shortly after she started feeling unnaturally tired. A private counselor diagnosed fibromyalgia and she has ME. She’s tried everything – acupuncture, counseling, Reiki – but the fatigue is crippling.

Name and address provided.

I understand your concern as your daughter has been unwell for six years. My feeling is that there is an unrecognized diagnosis playing in the background.

Fibromyalgia usually causes fatigue, poor sleep patterns, memory problems and persistent chronic pain – the condition is the most common cause of widespread musculoskeletal pain.

The closest we have as a test is a physical exam to check for 18 specific points of tenderness in soft tissues.

In some patients, their symptoms of fibromyalgia are very similar to those of myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS).

Like fibromyalgia, ME/CFS is an unknown cause disease that is also characterized by fatigue.

In the absence of a test, doctors make the diagnosis by relying on experience and skill – although I fear ME/CFS is all too often given as a relapse diagnosis for people with long-term severe fatigue. Because of the overlap of symptoms, it is not uncommon for people to be diagnosed with both conditions.

My thinking is that in your daughter’s case, the problem may be post-traumatic stress disorder (PTSD) or long-term postpartum depression.

PTSD can be triggered by a single frightening event – from your longer letter there is no doubt that this happened to your daughter during childbirth. Likewise, postpartum depression is a common but misunderstood and often ignored condition that can persist for years and lead to general malaise, as you describe in your longer letter.

I urge you to help your daughter see a psychiatrist, who can evaluate her based on a detailed review of her history and symptoms.

Then appropriate treatment can begin and there is reason to be optimistic. The first step is to ask her GP for a psychiatric referral.

My wife, 82, has had back pain for 45 years. A few years ago, things got worse, causing her to stop doing activities she enjoyed, such as bowling. In addition to degeneration of the lower back, she suffers from arthritis: her quality of life is poor, but the doctor’s only solution is co-codamol, which makes her sleepy. She also lives with Alzheimer’s disease.

David Crosby, Stafford.

Painkillers with an opiate (e.g. co-codamol) can be good for acute pain, but long-term use is not recommended due to side effects such as drowsiness and dependence. [File image]

It’s a heartbreaking situation for you. Managing dementia is a major burden in itself, but the main, immediate issue is pain management.

Painkillers with an opiate (e.g. co-codamol) can be good for acute pain, but long-term use is not recommended due to side effects such as drowsiness and dependence.

I wonder if there is a third element in your wife’s case in addition to the back pain and arthritis – possibly nerve entrapment due to the arthritis or collapse of one of the vertebrae, which could cause the symptoms you describe in your longer letter, including shooting. pain around the back of both thighs.

I suggest you and your wife talk to her GP and ask for a referral to a pain management clinic.

(Surgery to relieve nerve entrapment isn’t ruled out in a patient with early dementia – indeed many of your wife’s symptoms are much easier to treat if she doesn’t have chronic pain.)

In the meantime, a modest dose of an anti-inflammatory such as diclofenac, taken regularly, with occasional paracetamol, may be a good choice. And ask your GP about a home visit by an occupational therapist, possibly with a physiotherapist.

In my opinion… Personal checks not worth it

In the world of medical diagnosis, we sometimes use the term incidentaloma, a euphonious non-scientific term for finding an unexpected abnormality when running tests for another reason: we check for one thing, but find another.

I know someone who recently had an MOT, which included a colonoscopy, an examination of the intestines guided by a scan: this revealed cysts in her pancreas of a type likely to become cancerous. A quick operation avoided this.

In the world of medical diagnosis, we sometimes use the term incidentaloma, a euphonious non-scientific term for finding an unexpected test abnormality for another reason: we check for one thing, but find another

Yet the value of such MOT screening tests is controversial, not least when people have them done privately and then arrive at their NHS GP with an abnormality that may not be a problem, ie they have no symptoms.

There are other concerns: New blood tests to detect tumor markers have proved disappointing, with false positives and false negatives – yet you can get these as part of private MOTs.

I would recommend evidence-based national screening programs: those for cervical cancer and breast cancer, and stool tests for colon cancer. And instead of private MOTs, focus on prevention: maintain a healthy weight, eat healthy and exercise. There is so much more to gain.

• Write to dr. Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email: drmartin@dailymail.co.uk — add contact details. Dr. Scurr cannot respond to personal correspondence. Answers should be taken in a general context. In case of health problems, consult your own doctor.