Making Symptoms Worse: Some Causes You Might Not Have Considered

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By Bruce Campbell

You probably have recognized that overdoing intensifies symptoms and forces bed rest. That’s the famous cycle of push and crash. Here are seven other factors that can make ME/CFS and fibromyalgia symptoms worse and what to do about them..

1) Stress
Stress can be a challenge for anyone, but it can be doubly difficult for people with ME/CFS or fibromyalgia. First, chronic illness adds new stressors to the common challenges of everyday life. The new stresses include the discomfort of symptoms, isolation, financial pressure, strained relationships, and uncertainty about the future.

Second, ME/CFS and fibromyalgia are very stress-sensitive illnesses. They reset our "stress thermostat," so that the effects of a given level of stress are greater than they would be for a healthy person. In summary, your stresses are increased due to illness, and you are more vulnerable to the effects of stress.

But stress, like other aspects of ME/CFS and FM, can be managed using stress management techniques such as those described in articles here.

2) Other Medical Conditions
A majority of people with ME/CFS and FM also have other medical conditions as well. Here are some of the more common, listed alphabetically:

Allergies and chemical sensitivities
Arthritis
Depression
Endometriosis
Gastroesophageal reflux disease (GERD)
Headaches
Irritable bowel syndrome (IBS)
Food and digestive issues: Candida, Celiac disease, lactose intolerance
Mitral valve prolapse
Multiple Chemical Sensitivities
Myofascial pain
Orthostatic problems such as neurally mediated hypotension (NMH) or postural orthostatic tachycardia syndrome (POTS)
Sensitivity to light, sound, smell and touch
Sleep disorders such as apnea and restless legs syndrome
Temporomandibular joint disorder
Thyroid problems
Vulvodynia

Treatment of these other conditions can reduce a person’s overall symptom load. For suggestions about some of the most common conditions found with ME/CFS and fibro, see the article Overlapping and Related Conditions.

3) Medications
In addition to alleviating symptoms, medications can also create or intensify them. These unwanted consequences, called side effects, include fatigue, mental confusion, memory problems, sleepiness, sleeplessness, nausea, diarrhea, constipation, and dizziness.

Several of these side effects are also symptoms of ME/CFS and FM. In developing your symptom management plan, consider the possibility that some of your fatigue, mental confusion, sleep problems or digestive difficulties may be caused by a medication.

Drugs can trigger allergic reactions from the body, such as a rash, hives, swelling, wheezing or difficult breathing. If this occurs, stop taking the medication and contact your doctor.

For more on this topic, see the article Managing Your Medications.

4) Sensory Overload
If you experience confusion, fatigue or pain that you can't explain, one possible cause is sensory overload: receiving more sensory information than your body can process.

Sensory overload is a significant part of many people's experience of ME/CFS and FM. When we ask our groups to tell us what things make their symptoms worse, sense overload usually ranks in the top four, sometimes as high as number two.

People in our groups reported using two types of strategies in response to sensory overload. One is to remove themselves temporarily from the situation that triggered the overload. In addition to treating sensory overload once it appears, people in our groups also report using two forms of prevention: avoidance and setting limits.

For more, see the article Sensory Overload: Sources and Strategies.

5) Lack of Assertiveness
Another symptom-intensifier that often gets overlooked is lack of assertiveness. If we’re not able to stand up for ourselves and our needs, we’re likely to find it difficult to say “no” to demands that take us beyond our limits, triggering a relapse.

Unfortunately, being ill can make it difficult to be assertive. We may feel dependent on others or fear that we will be abandoned. But to protect our health, we need to communicate our limits to others in a way so that the limits are understood and accepted. In other words, to be assertive.

You can read an assertiveness success story in the article Assertiveness: A Tool for Reducing Symptoms. It describes how a woman in our community used assertiveness to handle visits from a friend so that, instead of resulting in relapses, they didn’t trigger a crash.

6) Elevated Heart Rate
Another cause of intensified ME/CFS or FM symptoms is a heart rate beyond our anaerobic threshold (AT), the rate beyond which we try to draw on reserves we don’t have. A helpful response: monitoring heart rate to stay below the anaerobic threshold.

For some people, monitoring heart rate is crucial to controlling symptoms. The people in our program who have benefited the most from heart rate monitoring tend to be those below 30 on our *Rating Scale and those with orthostatic issues such as POTS (Postural Orthostatic Tachycardia Syndrome).

About the benefits of a HR monitor, one person said "I've made a lot of progress in the past year, mostly thanks to heart rate monitoring, which trained me to reduce my activity to a level my body can handle."

For ways to calculate your anaerobic threshold and information on how to manage your heart rate, see the article Pacing By Numbers: Using Your Heart Rate to Stay Inside the Energy Envelope.

7) Emotions
Feelings such as sadness, worry, frustration and guilt are common and understandable responses to ME/CFS and FM. They are reactions to the changes, limitations and uncertainty brought by illness.

The two conditions make emotional reactions stronger than they were before and harder to control. The technical term is labile. People often say they cry more frequently, get upset more easily or have more angry outbursts than before they were ill.

How do emotions increase symptoms? Being in constant pain can trigger worries about the future. Worry leads to muscle tension, which, in turn, increases pain. If you feel frustrated at how little energy you have, your frustration will use up some of your energy, which can trigger a crash.

For ideas on managing the feelings triggered by ongoing illness, see the articles in the Emotions archive.