Fatigue is a common symptom among people with multiple sclerosis (MS) and it can be disabling and difficult to treat. Understanding its underlying cause and triggers can help you manage it better.
People with MS often describe their fatigue as a lack of physical and mental energy that affects their ability to carry out daily activities like cooking, exercising, and cleaning. Others describe a feeling of heaviness or weakness in the legs, mental fogginess, difficulty focusing, a sense of detachment from their environment, and the need to exert themselves more for basic tasks. The degree of fatigue can range from feeling tired towards the end of the day to a total inability to do anything.
Fatigue can be directly related to inflammation and damage to the nerves caused by the disease. It also may be caused by medications and other health complications such as infections or an under-active thyroid, sleep problems, and mood disorders. A poor diet and inactivity also contribute to fatigue.
For a normal movement to occur, the brain must tell muscle to move, which happens without delay. Due to nerve damage from MS, the signal transmission becomes slow and inefficient and with heat exposure or sustained exertion, it becomes even slower, resulting in worsening fatigue or weakness with continued exercise. In addition, if muscles weaken, they tend to tire more easily and quickly, making it harder to perform normal daily activities. Sometimes, even a little extra exertion leads to more fatigue.
Get Moving
People with MS once were advised to avoid regular exercise for the fear of making fatigue worse or triggering other symptoms. Today, the evidence supports the beneficial effects of regular physical activity. It improves endurance, cardio-respiratory function, muscle tone and strength, joint flexibility, balance, cognition, and mood. Even people with significant disability benefit from low- to moderate-intensity exercise.
Talk to Your Doctor
Ask your doctor for a referral, to a physical therapist especially if you have trouble starting an exercise program. Physical therapists can design a routine that fits varying degrees of ability and endurance and can teach you how to work out and plan activities in ways that conserve energy.
Start Low and Go Slow
Increase your pace and intensity gradually as your fitness improves. Rest as soon as you’re tired and don’t restart until the feeling of tiredness starts to fade away.
All Exercise Counts
Pick something you like and will stick with, taking into consideration any limitations, overall general health, and sensitivity to heat. Walking outside or on a treadmill, meditative exercises like yoga and tai chi, cycling or using a stationary bike, swimming, or dancing are all good options.
Lift and Stretch
Using light weights strengthens muscles while stretching improves muscle tone and relieves muscle pain and cramps in people with stiff or tight muscles.
Stay safe
Balancing exercises can help prevent falls and improve walking. Water exercise like swimming or aqua aerobics are easy on joints (compared with cardio exercises) and may keep body temperature lower. To avoid falls, pay attention to uneven surfaces and use assistive devices such as canes or walkers, as needed. When working out at home, keep the space uncluttered. And always swim with supervision or a companion.
Keep Cool
Heat can slow nerve transmission and provoke fatigue. By contrast, a cool core body temperature boosts performance and endurance. Take breaks, drink sips of cold water, and splash cold water on yourself or stand in front of a fan or an air conditioner. Or wear a cooling vest or neck wrap.
Ask About Fatigue-Related Medication
The evidence for treating MS-related fatigue with drugs is minimal and conflicting, but many doctors prescribe them, including amantadine, modafinil (Provigil), and amphetamine-like stimulants such as methylphenidate (Ritalin) and amphetamine-dextroamphetamine (Adderall). Most increase alertness and wakefulness but MS fatigue is not always due to or associated with excessive sleepiness. These drugs also have side effects such as headache, nausea, palpitation, and trouble sleeping (especially if taken late in the day) as well as anxiety, panic, hallucinations, and irritability. Consult your doctor right away if you have any of these side effects. The stimulants can suppress appetite and increase heart rate and blood pressure. People may develop a tolerance to them or become addicted.
Address Secondary Causes
Depression, sleep disorders such as insomnia and restless legs syndrome, thyroid dysfunction, urinary frequency or incontinence, nighttime cramps or spasms, and anemia all can contribute to fatigue. Antidepressants can improve fatigue and mood. Other medications may relieve pain and bladder dysfunction. Nortriptyline (Pamelor), an older antidepressant, may improve sleep and ease nighttime urination, and leg cramps. Maintaining good sleep hygiene and seeing a sleep specialist are also key. If the insomnia is related to anxiety and depression, consider a sedating antidepressant such as nortriptyline or paroxetine) or a nighttime anti-anxiety medication. Bloodwork can detect thyroid dysfunction (most commonly underactive thyroid gland) and anemia.
Review Your Prescriptions
Some antidepressants, muscle relaxers, and pain medications can cause fatigue and increased daytime sleepiness. If you’re taking any of these medications, be sure to review their side effects and benefits with your doctor. Reducing the number and dose of medications and managing symptoms without drugs (psychotherapy for depression, cognitive behavioral therapy for pain) can make a big difference.
