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Fatigue in multiple sclerosis
Fatigue is a universal sensation experienced by most people. Generally, fatigue is an effect which is proportional to the cause... for example the fatigue following exertion or lack of sleep. In any nervous system disorder, the affected person often notices that he or she tires more rapidly. In multiple sclerosis the fatigue can be out of all proportion to the activities taking place.
Fatigue is one of the most common MS complaints, being reported by over 75% of persons with MS. It is one of the most difficult symptoms to treat and understand and because it is invisible, its occurrence can cause misunderstanding, especially amongst family, friends and employers. Family members may think that a person with MS is not pulling their weight; sexual problems may arise between partners; employers may label a person as being lazy. Fatigue can have a devastating impact on daily activities, overall well-being and employment status.
The cause of MS fatigue is not fully understood. MS fatigue can be divided into four categories:
- Normal fatigue - This occurs whether or not MS is present. Not all fatigue is due to MS.
- Neuromuscular fatigue - This is caused by inefficient nerve conduction. Respite periods are the solution to this "short-circuiting" fatigue.
- Depression - Depression in MS is common and is often accompanied by poor sleep, poor appetite, depressed affect and fatigue.
- Lassitude - This is an overwhelming tiredness that comes on for no obvious reason. Because neurochemical medications are helpful management tools, it is thought that lassitude may be due to biochemical imbalances in the brain.
As well as disrupting daily life, MS fatigue can also cause anxiety when MS symptoms reoccur during periods of fatigue. This is particularly so after exertion and especially when activity or environment causes a rise in body temperature.It should be noted that fatigue is not related to relapses and fatigue does not cause worsening of the disease or a permanent increase in disability.
It is also possible that the impact and experience of fatigue may be exacerbated by psychosocial factors such as sense of control (i.e. the inability to manipulate, control or change the environment to suit personal psychological needs may be a factor in MS fatigue).
Management of MS fatigue
When fatigue becomes a major problem for the person with MS, a thorough medical evaluation should be undertaken to eliminate other causes of fatigue (eg infection). A possible cause of MS fatigue may be sleep disturbances, which then result in daytime fatigue.
If central nervous system disease (in this case MS) is the sole basis for the fatigue, then adjustments should be made to lifestyle, environment and occupation to accommodate the fatigue. It may be necessary to change your role, or shift your priorities within the family and at work, in order to pace yourself to avoid fatigue. Techniques such as time management, pacing, energy conservation, work simplification and relaxation breaks are all strategies which can be employed to control fatigue.
Practical tips:
- Avoid hot baths, very warm temperatures, excessive exercise, eating large meals, smoking
- Plan your life so work requirements, social occasions and late nights are staggered
- Follow a sensible diet, and reduce weight if overweight
- Yoga can be very helpful, combining exercise with meditation
- Keep physically fit, with a balanced programme of exercises that should be tailored to your capabilities. You should not be exhausted by these exercises and they should be followed by adequate rest periods.
Few pharmacological agents have been effective in combating MS fatigue. Amantadine (Symmetrel) has been shown to have some value in a percentage of patients. Management of depression (and assocated fatigue) should include antidepressant medication and counselling.
Stress management and counselling should not be ignored in the control of fatigue. Psychosocial factors and quality of life concerns impact upon the ability of people with MS to cope with their lives and may be a factor in the cause of fatigue as well as a determinant of the degree to which it interferes with daily living.
In managing fatigue in MS it is also important to educate families and friends and, as well, health care professionals and employers, as to the existence of this aspect of MS. Fatigue is very much a symptom of MS but one that can be managed if understood and accommodated.
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