MS Fatigue Treatment

MS fatigue is the most common symptom of multiple sclerosis and one that many people say has the biggest impact on their daily activities. The fatigue that happens in multiple sclerosis can have many causes, and feel different at different times. Identifying the different types of MS fatigue is crucial to determining what strategies you can use to manage your fatigue effectively. Recognizing the cause(s) of your MS fatigue can also help you know which members of your healthcare team you can lean on when you feel extremely exhausted and don’t know where else to turn.

Sources of MS Fatigue

What causes fatigue in multiple sclerosis?  With good detective work, you and your MS care provider can sort out the types of MS fatigue you are experiencing and address each of the factors that may be causing you to feel so exhausted.   

Lassitude (also called primary MS fatigue) 

Lassitude is unique to multiple sclerosis. It comes on suddenly, even after a good night’s rest, and tends to worsen progressively over the day. It is described as “feeling like walking through quicksand…walking with heavy weights on all four limbs…deep-down tiredness throughout the body…overwhelming or extreme exhaustion.”  

Lassitude is believed to be caused by the slowing of nerve transmission throughout the body, but the exact origins are unknown. 

Interrupted sleep 

Sleep for any of us is a precious commodity, but for a person living with MS – and their care partner – it can feel like a pipedream. A consistent lack of sleep can cause increased tiredness while you play catch up as your other multiple sclerosis symptoms continue. Sleep is commonly interrupted by: 

• Pain or discomfort 

• Stiffness and/or muscle spasms 

• Periodic limb movements  that may not awaken you but nevertheless disrupt your sleep cycle (and wake a care partner many times during the night) 

• Bladder symptoms that result in numerous trips to the bathroom 

• Mood changes, including anxiety, depression, and prolonged grief 

Deconditioning 

When physical impairments interfere with a person’s ability to stand and move, their muscles gradually become deconditioned.  

Muscle fatigue 

When nerve conduction is impaired by multiple sclerosis, muscles may not get the messages they need to function efficiently. When this occurs, a person’s legs or arms may suddenly “run out of gas” during activity.  

Cognitive Fatigue 

This type of fatigue occurs during periods of intense concentration and mental effort. It feels like “hitting the wall” or getting stuck mentally and being unable to continue. 

Treatment for MS Fatigue 

The first step your provider takes when working to address a person’s MS fatigue is to identify and address all the factors that may be contributing to it, including the ones described above. The fatigue that continues in spite of these interventions is lassitude. The next step is guiding you to the right provider that can help with strategies to manage the challenges you are facing.  

Healthcare Providers Who Can Help You Manage Your Fatigue

Physical Therapist (PT) 

•  Physical Therapists can recommend exercises that relieve stiffness and pain, improve mood, and possibly help reduce period limb movements. This can help with extreme tiredness and fatigue that is caused by interrupted sleep.  

• If you’re struggling with deconditioning or muscle fatigue, a physical therapist can also recommend strength, range of motion, aerobic, balance exercises, and adaptive equipment to enhance mobility. These exercises can help you maintain and improve your strength, mobility, and safety.  

• Mobility aids and adaptive devices can help conserve energy. A physical therapist can help you figure out which device is right for you, while also teaching you how to use it and pace your activities. Conserving your energy throughout the day can help manage your fatigue.  

• Your physical therapist can prescribe an exercise regimen to reduce your MS fatigue and increase your energy based on your specific abilities and needs. 

Occupational Therapist (OT) 

• Occupational therapists offer adaptive devices that will help conserve energy throughout your day.  

• An occupational therapist can teach you how to adapt and pace your activities to help with exhaustion levels.  

• Your occupational therapist can recommend organizational strategies and tools to reduce your fatigue, and teach you how to incorporate the 4 P’s into your daily life: 

• • Plan your schedule in ways that balance activity with rest 

• • Prioritize the activities and events that are most important and do them when you have the most energy 

• • Pace yourself, which means stopping before you hit a wall 

• • Position yourself, which means sit rather than stand when possible, and arrange your workspaces for ease and convenience 

Dietician  

• Can assist you with nutritional meal plans that are quick and easy to prepare.  

• A dietician can give you tips on how to simplify your meal preparation. 

Speech/Language pathologists, Occupational therapists, and Neuropsychologists  

• Offer strategies for preventing and/or managing MS muscle fatigue.   

A Pelvic Floor physical therapist and/or a Urologist  

• These members of your healthcare team can help treat your bladder symptoms, which can help with interrupted sleep and the feeling of extreme tiredness that follows you the next day.  

Cognitive behavior sleep specialist  

• Can help you achieve restful sleep with improved sleep hygiene techniques, stress management, and relaxation strategies.  

Medication Treatment for MS Fatigue

Once all the sources of your fatigue have been addressed, you may find that the lassitude persists in slowing you down. Your MS provider can prescribe medication to help treat your lassitude (e.g., Symmetrel®, Provigil®, Nuvigil®), certain antidepressants that are energizing, as well as Ampyra®, which increases walking speed and helps some people feel more energetic.

Summary

Fatigue is a complex MS symptom that requires careful diagnosis and an interdisciplinary team approach to manage it. There are multiple types of MS fatigue, yet they all can impact your life significantly. You lead the way by describing how it feels, when it occurs, and how it impacts your daily life.