Managing Fatigue in Multiple Sclerosis

When someone says they are tired, our first instinct is to offer them a way to relax and unwind. A good book, a hot cup of tea, or even an episode of their favourite series can be rejuvenating.

However, fatigue in Multiple Sclerosis (MS) is unlike any other kind of exhaustion. It is bone-tiring exhaustion, where even your mind has turned numb (lassitude). It is one of the most debilitating and pervasive symptoms experienced by individuals with MS.

MS-related fatigue can be extreme and overwhelming, significantly impacting a person’s quality of life. Although a result of the disease itself, other contributing factors can include poor sleep habits, inactivity, depression, and medications.

So what is it that we can do to make this kind of fatigue less onerous for the patient? Read on to know.

What is Multiple Sclerosis?

Multiple Sclerosis is an autoimmune, neurodegenerative and inflammatory condition that attacks the central nervous system (CNS). It corrupts the immune system, making it work against the body.

MS is a demyelinating disorder of the CNS, caused by breakage in the myelin sheath (a thin layer covering the axons of the neuron). When the myelin along with the nerve fibers are attacked and destroyed, scar tissue disrupts the communication routes between the CNS and the rest of the body.

Understanding Multiple Sclerosis Fatigue

Multiple Sclerosis fatigue is not your typical tiredness. It is often described as an overwhelming and persistent sense of exhaustion that is not proportionate to the person’s level of activity. This type of fatigue is different from the tiredness one might experience after a busy day; it can occur suddenly and can be extremely debilitating. It occurs in more than 75% cases and at any stage of the disease.

Fatigue in MS can interfere with daily activities, work, and social life. It affects not only physical abilities but also cognitive function and emotional well-being. Coping with extreme fatigue is a significant challenge for individuals living with MS. This is why it must be managed.

Lassitude is the term commonly used to refer to MS-related fatigue.

Characteristics of lassitude

People with MS can experience fatigue brought on by other factors such as vitamin deficiencies. It is important to ascertain whether the fatigue is related to the disease and not any other issue, as the treatment may differ.

Fatigue can take on different forms. Bladder dysfunction leading to multiple night awakenings can cause sleep deprivation which can lead to fatigue. Similarly, depression (brought on by an MS diagnosis, perhaps) can also cause fatigue. Patients who need to make considerable effort to perform daily tasks can also experience fatigue.

But what is lassitude? And how is it different from the types of fatigue mentioned above?

Lassitude occurs on a daily basis
It may occur early in the morning, in spite of sleeping well the night before
It tends to worsen as the day wears on
Heat and humidity can make it worse
It is the ‘uninvited’ symptom and can come on at any time of the day
It is far more severe than normal fatigue
It interferes with the quality of life and day-to-day functioning

Causes of fatigue in MS

The exact cause of fatigue in MS still remains unknown. However there are several theories that say:

Fatigue may be related to the general activation of the immune system. The high levels of cytokines may be a contributing factor.
Patients with MS may have to use more parts of their brain to perform the same task as someone without MS; fatigue may be a result of them having to work harder.
It is brought about by the reduction in electrical transmission of signals in the brain.

Other causes may include, restless leg syndrome (common to patients with MS), sleep apnea, alcohol or drug use, anemia, or reduced thyroid function.

Symptoms of fatigue in MS

There are two types of fatigue caused by MS, each having its own symptoms.

The first type is a feeling of general exhaustion. It could appear like feeling groggy for not having slept well the night before (when in truth, the patient may have slept well enough). This kind of fatigue makes the patient feel more and more gloomy as the day progresses, especially in the afternoons, or just after performing an activity. The patient may find it difficult to multi-task or perform as many activities as they used to previously (before MS).

The second type is muscular fatigue. Repeated or prolonged activity may cause extreme muscle tiredness. For example, after walking for a while, the patient may find that they are dragging one leg.

The thing to understand about fatigue is it interferes with regular activity. And when this happens, the patient may feel emotionally bogged down. This can lead to depression, which can lead to further exhaustion. It is a vicious cycle. And it needs to be managed effectively.

MS fatigue management

The first step to managing fatigue in MS is making certain lifestyle changes. These include:

Eat well-balanced meals
Regular exercise with a cardiovascular component
Break your day into sessions of work and rest
No smoking
Limit intake of alcohol
Avoid recreational drugs completely
Limit work that can make your muscles tense
Recharge batteries with an afternoon nap, a do-nothing day, etc
Avoid over-filling your day; to-do lists are not going anywhere, but you can do with some rest
Identify environmental triggers; avoid spending too much time in the sun (especially from mid-mornings to early evenings), hot showers, passive smoking
Manage stress and adjust expectations (especially those you have from yourself)
Practice relaxation techniques likes visualisation, breathing exercises, etc
Ask for help

Fatigue management with therapy

Making lifestyle changes is one part of fatigue management. The other part includes some therapies and strategies devised by your doctor. This will typically include:

Occupational therapy to make it easier to perform everyday routine activities at work and home
Physical therapy to perform daily tasks without using too much energy
Sleep regulation
Stress management
Heat management

Treating fatigue medically

While limiting the number of medicines is always a good idea, there are times when simply managing fatigue may not work well enough for you. At such times, your doctor may prescribe symptomatic medications like aspirin, modafinil, amantadine, etc. to help manage the exhaustion as well as replenish energy reserves.

Disease-Modifying Therapies (DMT) indirectly help manage fatigue by reducing disease activity.

Plexus Multiple Sclerosis Rehabilitation Program

Plexus is India’s first ISO-certified stem cell research centre that also provides holistic regenerative rehabilitation programs.

Our MS rehabilitation program involves a tailored treatment approach to help patients live fuller lives. Our team of expert doctors and therapists with over three decades of experience will devise a custom rehabilitation plan that tackles your symptoms, improves day-to-day functionality, and enables you to participate actively at home, work, school, and community at large.

Fatigue management is one of the most important aspects of our rehabilitation program along with:

- Functional strengthening
- Gait training
- Motor relearning
- Balance training
- Coordination training
- Hand function training
- Splinting for weak muscles
- Fall prevention training
- Activities for daily living training
- Emotional counseling

Speech therapy

Stem cell therapy

The wonder of this program lies in the results it has achieved. Patients have experienced –

Enhanced strength, flexibility, coordination, and general fitness
The joy of learning new skills
Improved mobility
More independence in daily activities
Improved cognitive function
Improved mental health

Multiple sclerosis does not have to be a debilitating disease. It does not have to wear you down. With timely intervention and proper guidance, you can live a life of dignity even with an MS diagnosis!

FAQs

Does MS make your body feel heavy?

Yes, MS can cause stiffness in muscles, difficulty in movement, and a feeling of heaviness.

Can MS fatigue be cured?

Fatigue can be regulated and managed with appropriate lifestyle changes, like exercises, balanced meals, as well as with treatments like occupational therapy, physical therapy, gait training, balance training, etc. Learning to use energy reserves frugally can help manage fatigue.

Do people with MS need naps?

Naps can help restore muscle strength and endurance while also replenishing energy reserves and giving rest to the body.

What vitamins help with MS fatigue?

Vitamins A, B12, and D can help manage fatigue.

Can Vitamin D reverse MS?

No. However, studies have shown that Vitamin D can lessen the risk of developing MS.

Does coffee help with MS fatigue?

Caffeine may help lessen MS fatigue in patients with milder cases of the disease. However, this area still needs research to prove the efficacy of coffee in the management of fatigue.