Multiple Sclerosis-Related Fatigue
Fatigue is the most common symptom of MS and one of the biggest causes of disability and decreased quality of life. People with MS have described it as feeling like swimming in a fur coat, wading through quicksand, or being under a lead blanket. It is also one of the hardest symptoms to explain to others. Fatigue is a feeling - a deep lack of energy and motivation - that cannot be detected on a brain scan, blood test, or physical exam.
What Causes MS Fatigue?
The exact cause of fatigue in multiple sclerosis (MS) is not entirely clear, but it likely comes from several sources. The inflammation that creates MS lesions can release chemicals in the brain called cytokines, which may directly cause fatigue. Damage to the brain’s nerve cells also plays a role. Neurons carry information throughout the body, and when those connections are damaged, the brain has to work harder to do the same tasks. MS fatigue is often made worse by warm weather or vigorous exercise that raises body temperature.
Secondary Causes of Fatigue
It is important to know that fatigue in MS is not always caused directly by the disease itself. Many MS symptoms can contribute to fatigue by reducing the amount or quality of your sleep. Anxiety, spasticity, pain, and bladder problems can all disrupt sleep, which then makes fatigue worse.
Your provider may also check for other health conditions that can cause fatigue, such as low thyroid hormone, sleep apnea, diabetes, anemia, or depression. Sometimes a sleep study can help make sure you are getting the most benefit from your sleep.
Some medications commonly used in MS can also contribute to fatigue. Baclofen, tizanidine, and gabapentin can all cause drowsiness. If you think a medication may be making your fatigue worse, talk with your provider - they may be able to adjust the dose or try a different option.
Managing Fatigue
There are medications that may help with MS fatigue, but the evidence for their effectiveness is relatively modest. For many people, a combination of medication and lifestyle changes works best. Here are some practical steps you can take:
Track your energy patterns. Keep a journal of when you feel most energized and when you feel drained. Schedule your most important or demanding activities during your best times of day. Think about which tasks are essential for you and which could be delegated to others.
Stay physically active. Even a small amount of regular exercise can make a big difference. A physical therapist can help you create a reasonable plan. (See also: [Managing Spasticity] for exercises that may also help with stiffness.)
Pay attention to your diet. Fatigue can affect eating habits, and poor nutrition can make fatigue worse. Try simple changes like replacing packaged snacks with nuts, seeds, or whole fruits. Use beans and lentils for protein without saturated fat. Aim for a colorful plate with plenty of fruits and vegetables.
Practice good sleep habits. Avoid drinking a lot of fluids right before bed, schedule a bathroom trip before sleep, and limit screen time in the evening.
Prepare for provider visits. Write down the most important issues you want to discuss before your appointment. This helps make the most of your visit time, especially when fatigue is hard to describe in words.
When to Talk to Your Provider
Fatigue is a complex issue with no one-size-fits-all solution, but sometimes simple changes can have a big impact. The first step is taking an honest look at what lifestyle changes are realistic for you. Managing MS fatigue often requires a multi-pronged approach, and your primary care and MS providers can help you build a plan that works. Many VA hospitals have specialized providers and therapists with access to the latest techniques for managing fatigue.
Based on an article by Christopher Hollen, MD.
