DOTS  are caused by genetic, lifestyle, dietary, environmental and psychological influences.  They maintain inflammation and imbalances that  cause ongoing pain, fatigue  related symptoms (physical, emotional, mental).

Often DOTS can be addressed by following a standard self management plan.  


HERES the basics of Self Management

HERES the basics of Self Management (with my annotations for people with FND/CSS pain syndromes)

  • Health Care - for infections, injuries and management of chronic health conditions see your GP.  Also see your doctor if you are experiencing severe or ongoin g side effects from medications.  (Tip for dealing with FND/CSS Pain syndromes, your concerns are likely to be dismissed unless you see a doctor with a good understanding of these -e.g. a doctor trained in Functional medicine or NEM)
  • Environmental and Toxicant Exposures -  Quit smoking, Cut back on alcohol, don't do drugs, and if necessary get help for substance abuse issues. This is standard self mangement advice.  (My add on although most doctors are aware that other environmental and toxicant exposures e.g. high pollution, mould chemicals can cause non specific symptoms like those complained about by people with depression and FND/CSS Pain syndromes, many fail to check for this, which can be done simply by taking an Exposure History)
  • Rest and Relaxation - get enough sleep and improve quality of sleep with sleep hygiene.  Medications may be prescribed if poor sleep is ongoing, and if ongoing and accompanied with lots of non specific symptoms (FND/CSS Syndromes) anti depressants, CBT , relaxation techniques or mental health support (psychologist, other) are usually advised.  (My add on for FND/CSS syndromes, medications (and even CBT)  can wind your nervous system up more, worsening sleep if you are low in cortisol, or have a very sluggish liver! or have pseudo Aspirin, NSAID and other medication sensitivities) 


  • Exercise and Diet: Follow Standard Dietary and Exercise Guidelines is standard self management for most people. For people with chronic pain and fatigue or low physical fitness   Graded Exercise Therapy (GET) is usually recommended. Working with a physiotherapist if you also have a physical injury. (My add on for FND/CSS syndromes, If you have  very severe fatigue any exercise including GET can make matters worse. If you have Vasomtor rhinitis standard exercise recommendations may make matters worse.  If you have food allergies, malabsorption issues or food intolerances, standard dietary guidelines may make you sicker if not adapted for these.) 
  • Smart Goals:  A standard self management recommendation for all with chronic illness / chronic pain and fatigue is to pace treatments and change based on SMART goals, best discussed with your doctor.  (I agree, if you don't you can experience painful flares that simply feed back into what is known as the push - crash cycle) 


To be most effective however, a Wellness Plan (self management) usually needs to be customised to your individual circumstances. One of the best ways to do this is to identify the DOT causes specific to you, then join the DOTS! and create a solution based wellness plan, ie map to guide you symptom relief land.   A doctor trained in the Functional Medicine Matrix or similiar (ie functional medicine or NEM) can help you with this.


Deficiences in enzymes, hormones, other that facilitate biological process such as energy making, detoxification and digestion, can lead to poor energy, and increased toxicity.  The consequences of these can lead to overactivation of the HPA axis - stress/survival response, causing changes to the nervous system  (sensitisation) and biological process that lead to pain, fatigue and pain syndromes.  Common deficiencies experienced by people with FND/CSS pain syndromes and related include:-


 Nutrient Deficiencies are common to people with FND/CSS pain syndromes and depression.  Having these conditions can deplete mineral and vitamins, include: those needed to for our body to create energy, function properly and relax (e.g.  B6, B12, Magnesium).  Nutrient deficiencies can also be caused by, or worsened by Poor Diet (addressed by changing to a health diet), and malabsorption diseases like Celiac Disease, and Inflammatory Bowel Disease (IBD).  Medical and appropriate management of these conditions is important to anyone who has these.  

If you are low in gut enzymes, you will experience tummy aches or digestive upsets and Irritable Bowel Syndrome (IBS),  Manage by reducing your intake of wheat and dairy and if needed other foods high in fodmaps, and reduce stress and anxiety..

Not enough good bacteria and too much bad bacteria in the gut has been linked to poor sleep, anxiety, fatigue and depression, as well as digestive upset. This can often be addressed with healthy diet, increasing sun exposure (Vitamin D) or increasing intake of resistant starch. Managing anxiety is also important due to the gut-brain axis.

If this applies to you, you will most likley have poor tolerance to many medications and experience heightened side effects. You may also have trouble with overall liver detoxification, which can make you prone to metabolic poisoning and related pain and fatigue, especially if your exposures to chemicals, mould, alcohol, drugs and other toxicants are high. Manage this by testing medication tolerance, that is starting on a lower dose than standard and increasing slowly, and avoiding drugs, managing alcohol intake responsibly and managine exposure to toxicants.  

Sunshine especially early in the morning, increases melatonin and promotes sleep.  Sunshine is also our main source of Vitamin D. Deficiency in Vitamin D has been linked to poor sleep, gut bacteria imbalances, pain and depression.  Vitamin D can of course be taken in tablet form, but these supplements can if not taken carefully, under medical supervision lead to toxicity issues



Overdoing  physical and mental exertion, health treatments, change, and exposures to sensory stimuli lead to pain and fatigue in everyone.  When you have a pain and fatigue syndrome  or related condition, the level at which over doing occurs, drops, sometimes very significantly.


Physical exertion when intense or repetitive cause pain. Physical exertion that uses your body in ways it is not used to will cause some discomfort until it adjusts. Physical exertion, when tired, sick, or already in pain, will lead to pain and fatigue flares, if the exertion is not PACED within your energy and tolerance limits.

Pushing yourself too much when fatigued and in pain, can cause flares. Any intense ongoing mental exertions (e.g. studying, solving problems - work other, can also cause fatigue and flares, particularly if you do not take regular rest and mindfulness breaks. When very tired or fatigued (e.g. chronic fatigue syndrome) even small amounts of mental exertion can cause flares. It is important to break down problems and tasks that require concentration into small manageable chunks. (SMART GOALS).


Still rearranging the content on this page sorry for any inconvenience



DEFICIENCIES: enzyme deficiencies, gut, liver and other are common to people with pain syndromes. They can be inherited, they are also linked to lifestyle, diet, stress and toxicant exposures
Get proper health care diagnosis and guidance. Functional Medicine or NEM is usually most beneficial for FND/CSS pain syndromes. Many other health professionals have poor understanding.
Poor ventilation, e.g. not opening the window, is the most common cause of building related illness (BRI, SBS). These are common to people with FND/CSS pain syndromes.

Poor sleep increases, pain, fatigue and syptoms: physical, emotional, mental -good sleep should be a high priority see tips here
Malabsorption and poor diets, lead to nutrient deficiencies and an inability to produce enough energy to keep up with daily demands (bio/enviro) without experiencing fatigue, pain and unpleasant symptoms.Rule out Malabsorption disease like Celiac, IBD and eat a healthy diet.
OVER DOING – doing too much (beyond your pacind and tolerance  limits!) and repetition causes pain and fatigue, and symptom flares.
Standard Treatments approaches,  can be aggressive for  many people wih FND/CSS Chronic Pain and Fatigue Syndromes.  Too many treatments all at once can be overwhelming and symptom triggering, rather than repairing. 
Sensory stimuli – noise, heat, fumes, fragrance always cause discomfort and pain, when high an potentially damaging.  It can also cause pain when not damaging, but when we are fatigued and our brain is having problem filtering betwen harmful and non harmful stimuli.  
When you are overtired, it can be hard to get to sleep even tired, because your nervous system is wired. This is a sign of too much anxiety and a high DOT stress load.
Very low calorie diets and low carb diets can deprive your body of the fuels it needs to make energy. While sometimes needed for health concerns, they must be supervised medically and by a dietician
Too muh exercise , like too little can cause pain, fatigue and symptom flares - find your pacing limits
Toxicants include: alcohol, drugs, pharmaceuticals (medicines, supplements, food chemicals), mould, chemicals like pesticides, solvents, mercury, lead and fumes and chemical gases (VOCS, MVOCS, PM), lymme tic, other. When we are exposed to high levels of toxicants it causes biological changes - and symptoms that mimic those experienced by people with depression and pain syndromes like fibromyalgia and CFS. Sometimes they are a contributing factor See here for biological effects of toxicity.
High or ongoing side effects, is a sign of medicine or supplement toxicity. Most commonly a sign of medicine or supplement sensitivity, toxic combinations, or medicine abuse or supplement abuse. (Overdoing, not taking as recommended)
High exposure to pollutants e.g. mould spores, chemical gases (VOCS), particulate matter, can be neurotoxic, causing symptoms associated with anxiety, pain and FND/CSS Pain Syndromes, and related e.g. Vasomotor Rhinitis.
Practise mindfulness and other relaxation impacts, to help counter the toxic impacts of anxiety, and help you relax and sleep better. (note: anxiety is a psychological, physical (high DOTS) and sensory condition)

Obesity - too much fat, particularly around the middle can have a toxic inflammatory impact on our health. Obesity can be a sign of poor diet, lack of sleep, and over eating and sedentary (lack of activity), it can also be a sign of high exposures to toxins (alcohol, industrial chemicals) or medical conditions like hypothyroidism.

Alcohol abuse (like drug, including prescription drug abuse) cause toxicity - liver, nervous system brain, as well as nutrient deficiencies. This has a distrastrous impact on body and mind, and also usually relationships!


Exercising in areas of high pollutants - Particulate Matter, can put at risk of having a heart attack. It can also trigger increased fatigue and pain and hypersensitivity (vasomotor, EI) symptoms. Chose a clean air space for exercise and physical activity.
Poor liver functioning (e.g. Cytochrome P450), Allergies, Pseudo drug allergies - Aspirin, NSAIDS etc., and Chronic Fatigue Syndrome (CFS) are all linked to medicine (and supplement) sensitivity and heightened side effects and risk of toxicity. Often careful choices, started on a low dose to test for tolerance 

Environmental Illness
High Chemical and mould exposure can cause fatigue, pain, headaches, muscular pain and other, it can also   put you at risk  of developing of depression,  Vasomotor Rhinitis, CIRS or another Environmental Illness.  Once Developed low exposures can  trigger allergic like symptoms. note genetics can predispose some people to environmental illness)

Sensory Sensitivity and high exposure to sensory stimuli e.g noise, heat, fumes, can interfere with your ability to relax and get a good nights sleep. (Create a sensory friendly bedroom and time out relaxation zone)
The most common symptom of food sensitivity is gut symptoms associated with natural sugar malabsorption (IBS) or Gluten Sensitivity (Celiac Disease). If a wide range of symptoms (gut and other) are occurring or being worsened by the foods you are eating it can be a sign of Allergy or Pseudo Allergy (Amines, Salicylates)
This occurs when we are sick with the flu or another infection, or when we have another medical condition, including FND/CSS Pain Syndromes. It is the way our body stops us from doing thing so it can focus on healing and rebalancing. Physical (exercise -other) and mental exertion intolerance is managed with PACING. When we do not pace we experience fatigue, pain and symptom flares. (note people with very severe CFS - bears, should not exercise)


Disclaimer: this information is for educational purposes only, it is not mean't to replace proper medical diagnosis and guidance.



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