A to Z of MS Fatigue

Fatigue is one of the commonest symptoms of multiple sclerosis and can often have a major impact on people's lives. The level of fatigue does not reflect the severity of someone's MS and people can experience fatigue that interrupts their daily life or that prevents them from working, whilst having no other symptoms.

Fatigue is very different from the tiredness or exhaustion that people without MS experience following strenuous exercise or a busy day at work. Fatigue is described as interfering with normal activity and being out of all proportion to any activity undertaken. It is often involves the sudden loss of energy and the inability to continue an activity. MS fatigue can not be worked through, as can sometimes be done with non MS fatigue, and recovery time also tends to be much longer.

Fatigue does not relate to relapses, nor to any permanent increase in disability. Previously experienced MS symptoms may get worse during fatigue but reduce again after rest. Fatigue can also affect cognitive symptoms such as short term memory, concentration or word finding. People report that it is harder to 'think straight' when they are fatigued.

As an 'invisible' symptom of MS, fatigue is sometimes not properly understood by family, friends or colleagues, who assume that the person with MS is depressed or just not trying hard enough. Fatigue is a major cause of early departure from the workforce.

Causes of fatigue

The cause of fatigue in multiple sclerosis is not well understood. It is thought to be a combination of slowed nerve messages from the brain and spinal cord and a build up of weakness in the muscles due to lack of stimulation. Heat can increase fatigue in MS and some people with MS find that symptoms get worse during spells of hot weather.

Fatigue can also be caused by the effect of living with MS. For instance, other MS symptoms, such as depression, being in pain or by having sleep disturbed by bladder symptoms or spasms can all make fatigue worse. Fatigue may also occur as a side effect of various medications or be the result of inactivity, stress, poor diet or an infection.

Fatigue can also be caused or worsened by other medical conditions and it is therefore important to have a comprehensive evaluation that can help identify the factors contributing to fatigue and develop an approach suited to the individual.

Treatment and management

Treatment is based on helping someone find ways of managing their life to prevent or lessen the impact of fatigue. The MS Trust book Living with fatigue is based on a fatigue management programme. Strategies include avoiding the build up of fatigue and conserving energy. In some cases drug therapy may also be appropriate.

References

Amato MP, Portaccio E.
Management options in multiple sclerosis-associated fatigue.
Expert Opin Pharmacother. 2012;13(2):207-16.
abstract

Braley TJ, Chervin RD.
Fatigue in multiple sclerosis: mechanisms, evaluation, and treatment.
Sleep. 2010;33(8):1061-7.
abstract

Krupp LB, Serafin DJ, Christodoulou C.
Multiple sclerosis-associated fatigue.
Expert Rev Neurother. 2010 ;10(9):1437-47.
abstract

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