Normal Tiredness and Fatigue Due to MS
There is ‘normal’ tiredness and then there is fatigue due to multiple sclerosis. Although it is often overlooked and thus may go untreated, fatigue in MS compounds the impact of other symptoms, significantly reducing an individual’s overall quality of life. Fatigue is cited by people with MS as the symptom that most affects their lives, even beyond problems with balance, weakness, numbness, pain or depression. Its negative impact on the ability to carry out daily activities can extend to the point of affecting one’s ability to care for oneself.
Fatigue can trigger a Catch-22 situation
You’re tired, hence you participate in fewer activities; less physical activity leads to muscle deconditioning including reduced cardiorespiratory capacity, which renders exertion even more exhausting…and unless it is interrupted, the cycle continues.
Fatigue can also affect mental functioning, such as verbal learning, memory and attention span. A variety of factors are associated with MS-related fatigue. The specific cause for MS-related fatigue has yet to be identified but impaired nerve conduction and damage to specific brain sites are the most likely causes. Activated immune response may also be a contributing factor. Damage to the central nervous system means more energy is required to maintain a constant level of neuronal activity [and hence, motor function]. Excessive heating can disrupt nerve conduction leading to exacerbation of fatigue. Theoretically, reduced use of glucose by the brain can also contribute to fatigue.
In addition to these primary contributors, secondary causes such as depression can increase the sense of fatigue. In individuals with MS, surprisingly, fatigue is not related to level of physical disability; however, it is clearly linked with depression, as research shows. Some investigators suggest fatigue and depression in MS have common mechanisms, including psychological factors and brain lesions. Indeed, one small study of 60 people with RRMS and depression reported that treatment for depression was associated with reductions in the severity of fatigue symptoms, and that this relationship was due primarily to treatment related changes in mood. More study is warranted to determine if antidepressant medications may improve fatigue in MS.
Many medications and drugs such as alcohol, caffeine and nicotine can contribute to fatigue by disrupting sleep patterns, for example. Medications that have been implicated in fatigue include some analgesics, interferon therapies, muscle relaxants, sedatives, some antidepressants and antihistamines. A number of medical causes can contribute to fatigue such as infection, anemia, diabetes, thyroid and cardiac disorders. Thus it is important to have your physician assess and treat any of these conditions.
Battling Fatigue
- Discover what triggers fatigue including various medications
- Adopt a healthy nutrition plan
- Pace yourself, plan effective use of your energy
- Find beneficial therapies such as an exercise program
“Always remember that you should never accept fatigue as an inevitable consequence of MS; many management options are available and you should keep working diligently with your health care team until your fatigue is eliminated or at least manageable.”
Lauren Krupp, author of Living Well with MS: Managing Fatigue