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

My daughter, now 40, had a traumatic birth six years ago — soon after she started feeling unnaturally tired. A private consultant diagnosed fibromyalgia, and she has ME. She has tried everything — acupuncture, counselling, reiki — but the fatigue is crippling.

Name and address supplied.

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

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

The closest thing we have as a test for it is a physical examination 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 called chronic fatigue syndrome (CFS).

Like fibromyalgia, ME/CFS is an illness of unknown cause also characterised by fatigue.

In the absence of a test, doctors diagnose it by relying on experience and skill — though I’m afraid too often ME/CFS is given as a fallback diagnosis for those with long-term severe fatigue. Because of the overlap of symptoms it’s not unusual for people to be diagnosed with both conditions.

My thought is that in your daughter’s case, the issue may be either post-traumatic stress disorder (PTSD), or protracted postnatal depression.

PTSD can be triggered by a single terrifying event — there is no doubt from your longer letter that this happened to your daughter in childbirth. Similarly, postnatal depression is a common but misunderstood and frequently ignored condition that can last for years, leading to general malaise, such as you describe in your longer letter.

I urge you to help your daughter see a consultant psychiatrist, who can assess her on the basis of a detailed appraisal of her history and symptoms.

Suitable treatment can then begin and there is reason for optimism. The first step is to ask her GP for a psychiatric referral.

My wife, 82, has had backache for 45 years. It became worse a few years ago, causing her to give up activities she enjoyed such as bowling. As well as degeneration of the lower spine, she suffers from arthritis: her quality of life is poor, but the GP’s only solution is co-codamol, which makes her drowsy. She’s also living with Alzheimer’s.

David Crosby, Stafford.

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

It is a heart-breaking predicament for you. Managing dementia is in itself a major burden, but the overriding, immediate issue is pain control.

Painkillers with an opiate (e.g. co-codamol) can be good for acute pain, but long-term use is not advised as side-effects include drowsiness and dependency.

I wonder whether as well as the back pain and arthritis, there is a third element in your wife’s case — possibly nerve entrapment due to the arthritis or collapse of one of the vertebrae, which would cause 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 about referral to a pain management clinic.

(Surgery to relieve nerve entrapment isn’t out of the question in a patient with early dementia — indeed many of your wife’s symptoms may be far easier to deal with if she’s not in chronic pain.)

In the interim, a modest dose of an anti-inflammatory such as diclofenac, taken regularly, with paracetamol now and then, might be a good choice. And ask your GP about a house visit from an occupational therapist, possibly with a physiotherapist.

In my view… Private checks that aren’t worth it  

In the world of medical diagnosis we sometimes use the phrase incidentaloma, a glib non-scientific term for finding an unexpected abnormality when carrying out tests for some other reason: we’re checking for one thing, only to find another.

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

In the world of medical diagnosis we sometimes use the phrase incidentaloma, a glib non-scientific term for finding an unexpected abnormality when carrying out tests for some other reason: we’re checking for one thing, only to find another

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

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

I would recommend evidence-based national screening programmes: those for cervical and breast cancers, and stool tests for colon cancer. And rather than private health MOTs, focus on prevention: maintain a healthy weight, eat healthily and exercise. There’s so much more to be gained.

• Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email: drmartin@dailymail.co.uk — include contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context. Consult your own GP with any health worries.