Do you suffer from joint pain and fatigue? Do you have trouble getting out of bed in the morning due to stiffness? Do you have trouble getting to sleep at night due to pain?

Here are some suggestions based on my experience as a doctor and patient with chronic pain and fatigue.

1. Exercise is the key to keeping joints mobile and raising energy levels. You need to start low and build up slowly with muscle stretching, gentle strengthening and aerobic (heart and lung) conditioning. It should be low impact on the joints such as walking or aquarobics(water therapy) 3-4 times per week for 20-30 minutes. Stretching and strengthening exercises can be taught by a physical therapist such as in pilates and Tai Chi.to avoid injury.

2. Pain relief with passive stretching,massage,heat and acupuncture. Be guided by your doctor regarding medication such as antiinflammatories.

3. Getting enough good quality sleep.This means finding a balance between activity and relaxation so you can wind down before you sleep. You need 6-8 hours per night. It should be in a quite comfortable environment. Relaxation time includes enjoyable activities such as hobbies, pleasant imagery from meditation and music, slow breathing and pampering such as a bubble bathe. Medication can help such as antidepressants.

4. Eat healthy and maintain a healthy weight. We are tending towards a vegetarian diet to maintain healthy weight.This means plenty of fruit and vegetables and limiting fats. A healthy weight is calculated according to your height and weight. To get the Body Mass Index it is:

Weight in kilos

(Height in metres) squared

Healthy BMI is 20-25;overweight is 25-30;obese is 30-40;

morbidly obese is over 40 which means you are more at risk of heart disease, arthritis and diabetes.

5. Work on emotional issues.This involves good communication. Stress gobbles energy. It triggers the fight/flight response which releases a cascade of stress hormones. Most emotional issues can be solved by good communication but where they can’t be solved you need to take a more lateral approach such as meditation and relaxation techniques to accept your feelings.

6. Fix any medical issues which are potentially treatable such as diabetes,anaemia and sleep apnoea(severe snoring)

7. Work on thinking to make thoughts more realistic and helpful and keep perspective.Mindfulness is being aware that we have a constant stream of thought that may help or hinder. Keep a diary or blog.