Chronic Fatigue: Understanding the Causes and Finding a Way Forward
Chronic fatigue can affect every part of daily life — work, family relationships, concentration, motivation and even simple routines. Many people describe it as a deep physical and mental exhaustion that is out of proportion to activity and does not reliably improve with rest.
One of the most difficult aspects for patients is feeling that their symptoms are not always fully understood or taken seriously, particularly when initial test results appear normal. In reality, fatigue is a common but complex symptom, and understanding its cause requires a careful, structured and open-minded approach.
Fatigue Is a Symptom, Not a Diagnosis
Fatigue is not a condition in itself. It is a symptom that can arise from a wide range of medical, inflammatory, psychological and lifestyle-related factors. In some people, fatigue may be linked to autoimmune or inflammatory rheumatic disease. In others, it may reflect a different underlying medical issue — or a combination of factors acting together.
Importantly, fatigue can persist even when a known condition appears “stable” on blood tests, and it can also occur in people who do not yet have a clear diagnosis.
Why Listening Matters
A meaningful assessment of fatigue begins with careful listening. Understanding how fatigue started, how it behaves day to day, and how it interacts with other symptoms is essential.
One patient described their experience after specialist assessment:
“Dr Singh has really helped me to improve my chronic fatigue and was the first doctor I saw who listened to my concerns and took them seriously. I have seen a great improvement in my energy levels in the last year which I attribute to Dr Singh’s treatment.”
This reflects a key principle: fatigue often improves when it is properly explored, validated and addressed, rather than dismissed or attributed to a single cause too early.
Possible Causes of Chronic Fatigue
Fatigue is often multifactorial. Potential contributors include:
Inflammatory or Autoimmune Conditions
Active or partially controlled inflammation
Immune system activation even when routine markers are normal
Overlap with pain, stiffness and poor sleep
Other Medical Causes
Anaemia
Thyroid disease
Vitamin deficiencies (iron, B12, vitamin D)
Hormonal or metabolic conditions
Post-viral or chronic infection-related fatigue
Cardiopulmonary disease
Medication Effects
Sedation or fatigue related to prescribed treatments
Cumulative effects of multiple medications
Sleep, Lifestyle and Functional Factors
Poor sleep quality or unrecognised sleep disorders
Physical deconditioning
High work or caring demands
Prolonged stress
Psychological and Cognitive Contributors
Anxiety or low mood
Cognitive overload
Adjustment to chronic illness
For many people, fatigue reflects several of these factors at once, rather than a single explanation.
How Chronic Fatigue Is Assessed
A structured assessment focuses on understanding the whole clinical picture, rather than relying on one test.
1. Detailed Symptom Review
This includes:
Onset and duration of fatigue
Daily pattern and fluctuations
Relationship to activity, rest, pain and sleep
Associated symptoms such as breathlessness, brain fog, weight change or low mood
2. Medical Context
Fatigue is considered alongside:
Past and current medical conditions
Autoimmune or inflammatory disease where relevant
Medication history
Recent illnesses or significant life events
3. Physical Examination
Examination can provide important clues, including:
Signs of systemic illness
Evidence of inflammation
Musculoskeletal contributors to pain and poor sleep
Investigations: Used Thoughtfully
Investigations are guided by clinical findings and are used purposefully, not indiscriminately. Depending on the situation, these may include:
Full blood count
Inflammatory markers
Thyroid function
Iron studies, vitamin B12 or vitamin D
Renal and liver function
Additional tests where clinically indicated
Normal results do not mean symptoms are imagined or insignificant. Instead, they help narrow the differential diagnosis and guide management.
Approaches to Management
Medical Management
Medical treatment focuses on addressing identifiable or reversible contributors, which may include:
Optimising control of inflammatory or autoimmune disease where present
Treating anaemia or vitamin deficiencies
Reviewing medications that may worsen fatigue
Managing pain or sleep disruption more effectively
Non-Medical and Supportive Strategies
Non-pharmacological approaches are often just as important:
Improving sleep quality and routines
Energy pacing rather than pushing through exhaustion
Gradual, tailored physical activity
Addressing stress, anxiety or low mood where present
Practical adjustments at work or home
These strategies are not about minimising symptoms, but about supporting recovery in a realistic and sustainable way.
Why Follow-Up Is Important
Fatigue rarely improves overnight. Progress is often gradual and benefits from review over time. Follow-up allows:
Reassessment of symptoms
Adjustment of management plans
Monitoring response to treatment
Ongoing reassurance and support
Patients frequently say that knowing there is a structured plan — and that symptoms are being taken seriously — is itself reassuring.
When Specialist Input Can Be Helpful
A specialist assessment may be particularly valuable when:
Fatigue is persistent or worsening
Symptoms are complex or unexplained
There is overlap between multiple possible causes
Previous assessments have not led to clarity
Fatigue is significantly affecting quality of life
A broad, general-medical and rheumatology-informed approach helps ensure important causes are not missed and that management remains balanced and individualised.
Trusted Patient Information Resources
For further reliable, patient-friendly information, the following websites are recommended:
NHS – Tiredness and Fatigue
https://www.nhs.uk/conditions/tiredness-and-fatigue/Versus Arthritis – Fatigue
https://versusarthritis.org/about-arthritis/symptoms/fatigue/ME Association (for broader fatigue information)
https://meassociation.org.ukBritish Society for Rheumatology (patient information)
https://www.rheumatology.org.uk/patients
These resources complement clinical assessment and provide further context for patients seeking to understand fatigue.
In Summary
Chronic fatigue is common and real
It can arise from autoimmune disease, other medical conditions, or non-medical factors
Normal tests do not invalidate symptoms
Careful assessment and targeted investigation matter
Improvement is often possible with a structured, whole-person approach
With thoughtful evaluation and appropriate support, fatigue does not have to be something patients simply endure.
Please note, these posts are for general information only and do not constitute medical advice. Dr Singh would encourage you to speak to your healthcare professional to be assessed and managed for your specific symptoms.