Q. Kindly suggest me a therapy to overcome fatigue and body pain.

Answered by
Dr. Naresh Kumar Monigari
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 08, 2016 and last reviewed on: Dec 22, 2020

Hello doctor,

The primary concern surrounding my inquiry is body pain and fatigue. I have lymphedema in my lower legs since eight years. Intermittently, the condition is mediated with compression stockings, massage therapy and occasional stationary exercise. The swelling persists with activity, just to a lesser degree as long as garments are applied. At this point, there is slight pitting. The tissues from the calves down to the feet are consistently engorged and tough. Extensive rest is required to adjust leg shape from the calves down from columnar to moderately curve. The condition has limited impact on my physical activity and energy. It manifests as pain and hence, there is related slowing down after cardiovascular sports.

Before six years, I began experiencing upper respiratory infections several times a year, coinciding with or without any flu or cold, requiring days of rest and OTC medication to recuperate. The timing coincided with a change of place and so, I presumed climate adjustment may have been the culprit. But, the symptoms have persisted ever since, with or without vaccinations. I had signs of anemia since my young age and got to know the diagnosis in after a year following the testing related to a women's wellness examination. A year later, lethargy and moderate pain of the lower extremities became a regular occurrence regardless of the physical activity. The symptoms would subside over time with rest. Migraine pain also emerged that year, seeming to coincide with sinus activity, due to the pain's concentration around the forehead and eyes, and required the use of OTC pain relievers. Migraines had not been a concern prior to that point.

Then, the lethargy and body ache became a more persistent fixture, occurring several days a week, weekly, subsiding on its own, regardless of the amount of rest. Last year, the lethargy overwhelmed the physical pain and is remaining at the same frequency, but coupled with a spike in symptoms of anxiety, such as difficulty in concentrating, aphasia, heightened fear around mundane circumstances and nausea. Additionally, during winter a brief exposure outdoors at night resulted in Raynaud's disease in the fingertips of both hands for about a month, until it started to warm outside.

Since the beginning of this year, the ongoing fatigue has occurred daily and the body ache occurs throughout the day, regardless of rest or activity. The pain is usually dull all over, but also presents with inflammation around the joints (knees, elbows, wrists and ankles) and muscle soreness primarily of the mid and lower back. Daily use of extra-strength OTC pain reliever is now necessary, though I try to refrain from every day use as much as possible. Dull headache pain, in the front region occurs several times a week, as do issues of concentration and mental fog. Additionally, twice this year I have experienced syncope. I am attaching the results of recent blood work, which was completed during my menses. Previously, I was taking Acetaminophen. Currently, I am taking Aspirin. Please help with my condition.



Welcome to icliniq.com.

  • The laboratory reports (attachment removed to protect patient identity) show mild anemia and microscopic hematuria.
  • The anemia looks like dual deficiency (iron and B12), but we need to do reticulocyte count, peripheral smear, serum iron, total iron binding capacity (TIBC), ferritin, erythrocyte sedimentation rate (ESR), thyroid profile and serum vitamin B12 levels to confirm the cause.
  • Though the common cause of anemia in menstruating females is iron deficiency, the red blood cell indices are not in favor of iron deficiency anemia. So, we need those tests.
  • Hematuria may be because of many causes, but mostly due to stones and urinary infection. So in your case, there does not appear to be any infection and hence, we need to rule out stones by ultrasound or by a repeat urine microscopy examination after five days. If the hematuria persists, then we need further tests.
  • Regarding your symptoms, do you have any tension or work stress? Was anything confirmed like sinusitis and have you taken treatment before?
  • You said about Raynaud's, but it does not look like Raynaud's. The classical Raynaud's have associated skin changes like white followed by blue and then red, which happens in minutes and not days.
  • Raynaud's can happen as a primary disorder where the prognosis is good and not associated with complications.
  • Raynaud's as a secondary disorder is associated with other connective tissue disorders, but in your case, the antinuclear antigen (ANA) is negative, which rules out connective tissue disorders.
  • The treatment for Raynaud's includes avoiding cold weather and wearing protective clothing. Only in severe cases, calcium channel blockers like Nifedipine are used.
  • The symptomatology of a headache appears more of a tension headache rather than a migraine.

Revert back with more details to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

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