Fighting Fatigue in Multiple Sclerosis

First you have to know what you're up against

Man waking up in his bedroom while sitting at bed
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Fatigue is one of the most frustrating symptoms of multiple sclerosis: You'd love to be more active, but often you don't have the get-up-and-go to, well, get up and go. It may comfort you to know you're not alone: Most people with MS suffer from fatigue. It's so common, in fact, that there's a name for it: "MS lassitude." There's no cure for the extreme exhaustion caused by MS, but depending on what's causing it, there are things you can do to re-energize so you can enjoy your life and function better.

Dealing With Common Energy Sappers

If fatigue is interfering with your daily life, make an appointment with your doctor. Before you see her, keep a "fatigue log"—any time you're overwhelmed by exhaustion, jot down the time of day, what you were doing, when you last took medication, and a description of how tired you were (did you just need to put your feet up or were you so wiped out you had to go to bed?) Include anything you did to try to rejuvenate yourself, whether it worked or not.

This will help your doctor home in on what's making you tired and come up with a strategy for dealing with it. For example, if your fatigue came on suddenly or has gotten worse, she may suspect you've had a relapse (in which case she'll likely send you for an MRI). Here are some other potential causes of MS lassitude:

Disease-modifying treatment. Fatigue is a potential side-effect of interferon-based medications.

That's why it can pay off to note in your log when you last had a treatment: If you were totally wiped out the day after an injection or infusion, a change in your treatment schedule to accommodate the fatigue that follows may help—for instance, switching from a Monday to a Friday so you can rest on Saturday.

There also are medications for treating MS-related fatigue. Your doctor may prescribe one these. If that doesn't perk you up post-treatment, Ritalin (methylphenidate), a central nervous system stimulant, may do the trick.

Certain MS medications. Sometimes fatigue is a side effect of a drug you're taking to deal with a specific symptom, such as muscle spasticity, or to relieve pain. If your doctor suspects that's what's going on in your case, she may switch you to another medication or alter your schedule so that you take your largest dose at night so you can sleep it off.

Insomnia. Sleep disturbances are common in people with MS. Muscle spasms, depression, anxiety, pain, and nocturia—the need urinate frequently during the night—are all possible reasons for losing sleep, and each will need to be dealt with separately. What's more, the corticosteroid Solu-Medrol (given intravenously to treat inflammation around lesions) causes both insomnia and anxiety. Since this powerful medication is given on a short-term basis, your doctor may prescribe a sleeping aid or anti-anxiety drug to help you get the rest your body needs.

Physical activity. If your MS makes it hard to walk or keep your balance, or simply do everyday tasks, the physical challenges can cause you to overexert yourself.

In this case, the solution may be physical therapy to build up muscle strength and improve balance. An occupational therapist may be helpful as well. She can teach you tricks for moving more efficiently so daily tasks are less draining.

Depression. If feeling blue has you exhausted, your doctor may prescribe an anti-fatigue drug to see if perking you up physically also cheers you up emotionally. If you're still depressed, a psychiatrist may suggest you try an antidepressant.

Infections. The flu, a urinary tract infection, or even a garden-variety cold can leave anyone feeling under the weather.

Since flu and most colds are caused by viruses, the best thing to do is listen to your body and rest until you feel better. If it turns out you have a urinary tract infection, a course of antibiotics may be all you need to get back on your feet again.

Source:

Birnbaum, M.D. George.  Multiple Sclerosis: Clinician’s Guide to Diagnosis and Treatment, 2nd Edition. 2013, Oxford University Press.

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