Primary care
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Chronic benign pain is commonly associated with chronic fatigue and depression. Depression and chronic fatigue syndrome are also associated with each other and often include pain. ⋯ Management requires separately addressing each component of patients' distress and usually includes physical rehabilitation, education, administration of nonhabituating medications and often counseling. Depression may be a favorable prognostic sign, as it suggests a treatable condition and provides incentive for recovery.
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Exercise should be part of everyone's lifestyle, but may be a particularly important part of the treatment of patients with depression and chronic fatigue. It will reliably and consistently decrease feelings of tiredness and despondency, although it is seldom sufficient as a sole treatment intervention for such patients. When initiating an exercise program, a baseline assessment should be followed by an exercise prescription and an appropriate degree of patient education about exercise physiology. This should be followed, in addition to other treatment interventions, by regular follow-up visits to make appropriate adjustments; provide encouragement and motivation to continue; monitor weight, body fat, and nutrition; and assess the effectiveness of the program on the underlying problem.