Managing Multiple Sclerosis Fatigue
Fatigue is the most common MS symptom—experienced by 75 to 95 percent of people living with the disease. Approximately 50 to 60 percent of people with MS describe fatigue as one of their most troubling symptoms, regardless of their disease course or level of disability. Fatigue can interfere with a person’s ability to function at home and work, and is recognized by the Social Security Administration as a significant cause of unemployment among people with MS.
Fatigue is defined as a subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities. There is no single contributing factor that causes fatigue in people with MS, and because of this it is important to identify the root cause. Fatigue might be the result of disrupted sleep, weak or de-conditioned muscles, co-existing medical illnesses, side effects of medication, and depression.
People with MS may also experience a special type of fatigue, called lassitude, which:
• Generally occurs on a daily basis
• May occur early in the morning, even after a restful night’s sleep
• Tends to worsen as the day progresses
• Tends to be aggravated by heat and humidity
• Comes on easily and suddenly
• Is generally more severe than normal fatigue
• Is more likely to interfere with daily responsibilities
Once the source of the fatigue has been identified, treatment is geared toward reducing the contributing factors. Ways to reduce fatigue include:
- Management of conditions that interfere with sleep (such as sleep apnea, leg spasms, depression, MS symptoms (such as bladder dysfunction, spasticity, or pain) and co-existing medical conditions, including depression, that cause fatigue
- Adjustment of medications that cause excessive fatigue and/or sleepiness (such as anticonvulsants, antihistamines, anti-hypertensives, sedatives, and certain antidepressants)
- Physical therapy to improve strength, reduce physical symptoms (such as weakness, spasticity, and ataxia) that may increase fatigue, and learn strategies to modify activities to conserve energy (including the use of assistive devices)
- Occupational therapy to simply tasks and suggest environmental modifications to make activities more energy-efficient
- Cooling strategies to avoid the fatigue caused by elevations in core body temperature due to heat, exercise-related exertion, and fever
- Stress management techniques, meditation, and psychotherapy
- Medications - such as amantadine (Symmetrel®), armodafinil (Nuvigil®), or Methylphenidate (Ritalin®) - although not FDA-approved for MS are commonly prescribe to combat MS-related fatigue
Fatigue is a complex, potentially debilitating symptom experienced by the majority of people with MS. Anyone experiencing ongoing fatigue, or the sudden onset of severe, disabling fatigue should consult his or her physician so that the factor(s) contributing to the fatigue can be identified and effectively managed. Successful treatment of fatigue may require a combination of interventions, including behavioral adaptations, environmental modifications, and medication.
For more information regarding fatigue, read the “Fatigue and MS” special issue of MS in Focus published by the Multiple Sclerosis International Federation in January 2012.