Overview:

One of the most common symptoms of multiple sclerosis is fatigue with some studies claiming up to 90% of people enduring life with MS experience fatigue. Fatigue can be physical, mental or both affecting a persons ability to work, ability to take part in family functions, ability to take part in social functions or even get out of bed.  Fatigue in multiple sclerosis can impact the patients for hours, days or even months and can be extremely debilitating.

A patient’s limbs may feel heavy and difficult to use even to the point of needing to lie down immediately.  Levels of physical and mental fatigue are often described by patients to be completely draining.  Cognitive fatigue can result in difficulties following a conversation, producing words, numbers affecting either or both the person’s input or output capabilities.

Fatigue is considered an “invisible symptom” as people do not physically see the disability.  Additionally, while healthy people may understand fatigue they often have difficulty understanding fatigue to the point it is debilitating especially if an MS patient has seemingly not engaged in any activities they feel may warrant exhaustive fatigue.

It is a serious matter with multiple sclerosis as the levels of fatigue can result in emotionally draining feelings such as depression, lack of will and a host of other emotionally draining issues that form a sort of MS cascade effect.  Thus fatigue is a symptom that should be dealt with as a primary goal to staving off additional problems related to multiple sclerosis.

Multiple Sclerosis Fatigue Facts:

  • Woman YawningOnset: It can begin suddenly.
  • Frequency: It often occurs every day.
  • Time of day: It can occur in the morning, despite having slept the night before.
  • Progression: It commonly worsens throughout the day.
  • Heat-sensitive: Heat and humidity often aggravate the condition.
  • Severity: It tends to be more severe than a healthy person’s consideration of fatigue.
  • Effect on activities: It is more likely than regular fatigue to disrupt ability to perform everyday tasks.
  • Considerations: Healthy people often relate fatigue in MS to laziness which is completely incorrect.

Why does fatigue occur in MS?

The exact cause of fatigue with multiple sclerosis has yet to be discovered though many theories exist. One theory, for example,  suggests the fatigue occurs due to a general activation of the immune system resulting in Cytokines which are chemical messengers being activated and the higher levels result in fatigue.  Descriptively it is described as though feeling like one has a virus all the time.

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A differing theory suggests that people with MS experience the fatigue due to the reduced electrical transmission of signals in the brain.  Yet another theory is that people living with MS need to use more parts of their brain to accomplish tasks due to disease damage in the Central Nervous System (CNS). Thus their brain must work harder than a healthy person to perform the same tasks.

Many multiple sclerosis researchers believe that structural abnormalities in the brain are the cause of fatigue as a result of the demyelination associated with the disease. Loss of neurons results in structural damage inducing fatigue.  Some believe the fatigue

Hormone production issues via the pituitary gland within the brain is another theory for MS fatigue.  The pituitary gland is often referred to as the “master gland” of the body due to its function in regulating other endocrine glands.  A portion of the brain called the Hypothalamus determines which hormones the pituitary gland should release via electrical and chemical messaging.  Damage to the brain due to multiple sclerosis may distort or wrongfully interact in this process.

For many years it was thought that multiple sclerosis did not impact the autonomic nervous system.  The autonomic nervous system is responsible for our autonomous functions such as breathing, digesting and other “automatic” functions.  Some researchers believe that fatigue may be related to the autonomic control of a patient’s heart or chemical changes within the heart muscle.

Presently the cause of fatigue in multiple sclerosis patients remains a mystery and significant research continues to find the cause and solutions.

Treatment of Fatigue in Multiple Sclerosis:

Medications for the treatment of fatigue are available but few options do exist.

Medications:

  • Symmetrel® (Amantadine Hydrochloride) is an antiviral medication which is also used in Parkinson’s disease.  Clinical trials of Amantadine showed small, inconsistent improvements in the ranges of 20%-40% short term help in fatigue management.
  • Provigil® (Modafinil) is another medication that has shown improvements and positive effects in small short term studies.  Additional studies have been recommended to research the effects of long-term usage and to ascertain appropriate dosing.  Modafinil is a wakefulness-promoting agent (or eugeroic) used for the treatment of wakefulness disorders such as narcolepsy, shift work sleep disorder, and excessive daytime sleepiness associated with obstructive sleep apnea.  While modafinil was developed to treat narcolepsy (excessive sleeping), in recent years has also been used off-label in multiple sclerosis.  Often called the ‘smart drug’ modafinil may promote cognitive enhancement.  Studies on sleep deprived people have shown a strong effect on cognitive functions.  Scientifically there has not been much attention of consensus on the efficacy of the medication as a cognitive enhancing treatment in people not sleep deprived.A newer review published online by the Journal of European Neuropsychopharmacology stated that Modafinil does have a significant cognitive benefit at least on some subsets of tasks.  Off-label students in colleges in preparations of exams have used the medication and hence its coined term ‘The Smart Drug’ claiming increased alertness, wake time and cognition improvements.Read more about Modafinil.

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  • Aspirin: A recent well-designed study showed that two regular (325 mg each) aspirins taken twice a day significantly reduced MS-related fatigue and was preferred by patients over placebo. Aspirin is inexpensive and readily available over the counter. However, some people are sensitive to aspirin, and others may find it causes stomach ulcers. A trial of aspirin therapy for fatigue may be a reasonable first step in medication management. Usually, the effect can be seen after a month or two as reported by the Cleveland Clinic a well respected MS resource.
  • Low-Dose Naltrexone (LDN): Tens of thousands of people use Low-Dose Naltrexone (LDN) globally to help manage their multiple sclerosis symptoms.  While LDN has not had any large-scale clinical studies in respect to its usage in MS many people have found beneficial results taking this medication.  LDN has been used by many MS patients for over 20 years but is not approved by the FDA for usage in multiple sclerosis.  In recent years neurologists have become more open to trying LDN with patients given its realatively safe profile.In general, in people with diseases that are partially or largely triggered by a deficiency of endorphins (including cancer and autoimmune diseases), or are accelerated by a deficiency of endorphins (such as HIV/AIDS), restoration of the body’s normal production of endorphins is the major therapeutic action of LDN.  The brief blockade of opioid receptors between 2 a.m. and 4 a.m. that is caused by taking LDN at bedtime each night is believed to produce a prolonged up-regulation of vital elements of the immune system by causing an increase in endorphin and enkephalin production.In use of the medication the results are seemingly variable and should be closely watched and documented.  Some people claim spasticity is reduced and even removed. Vastly reduced levels of fatigue, incontinence existing before engaging in an LDN therapy completely disappearing and many other positive aspects.  Some people report no changes.  In some areas of the world LDN has been used as a disease modifying therapy claiming reductions in exacerbation.  What is generally known is LDN does have a significant impact on multiple sclerosis and it is important to “fine tune” the dosage for maximum benefits.  Additionally the medication must be taken at a certain time before bedtime.  Often people taking LDN also need to take a medication to assist with sleeping.
    LDN metabolization occurs in the liver and thus concern of using LDN has existed in combination with disease modifying therapies that also metabolize in the liver causing strain on the liver.

    Naltrexone is approved by the U.S. Food and Drug Administration (FDA) for the treatment of addictions to opioids and alcohol. At the full recommended dose, Naltrexone blocks opioid docking sites on cells.

    At significantly lower doses, Naltrexone has been prescribed as a treatment for a variety of diseases, including various types of cancers, HIV/AIDS, Parkinson’s disease, Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), emphysema, as well as multiple sclerosis (MS) and other autoimmune diseases. There has been limited clinical study of low-dose Naltrexone (LDN) to treat MS.

    Before considering LDN as part of your management of multiple sclerosis be sure to consult your neurologist.  If you are on a disease modifying treatment request your neurologist contact the pharmaceutical company accordingly to see if LDN can be safely used in conjunction with the disease modifying therapy.

    We will shortly have an article online in respect to LDN as well.

Most people afflicted with MS have had to utilize a more logical driven life in order to cope with the levels of fatigue the disease brings forth.  Prioritizing each day can be helpful and setting a schedule in advance.

Some of the mechanisms people have found to reduce fatigue (in no particular order):

  • Taking a nap during the day
  • Working part-time .vs. full-time.  A recent study suggested that a large segment of people who are afflicted with MS are out of the job sector within 5 years of the onset of the disease. Click Here To Read The Article.
  • Ask for help with daily household chores.
  • Regular exercise is important in combating physical fatigue. Exercise with a friend can be beneficial in getting a proper regiment.
  • Fatigue CartoonTaking short breaks during the day to just relax.
  • Using a Nutri-bullet or juicer with proper recipes of can assist energy levels.  I start each morning with a Nutri-Blast and it helps a ton with me.
  • Maintaining a balanced diet.
  • Having nutritional levels tested in blood tests for deficiencies and getting them corrected.
  • Avoid cigarette smoking.
  • Maintain proper weight.
  • Create mechanisms in daily life so you are not expending extra energy.  Think out what you do each day and create a few ideas through logic or research to make daily tasks easier.  Try each of them to find the most effective ones and then put them into practice each day.  A simple example would be in cooking make sure all ingredients are accessible so you are not chasing them.  Plan meals ahead of time so you are not making excessive trips to a grocery store for example.  These small changes add up to large energy expenditures.  Mitigating them by coming up with new ways can provide significant gains over fatigue.
  • Avoid stress as it can bring on fatigue.
  • Physical and / or occupational therapy.
  • Sleep management.  Sleep management meaning finding you most relaxing sleep. For example the position you sleep in, staying warm, not hot and not cold. Mood background music and more.
  • Avoid heat exposure. Use a cooling vest, air conditioning or cool showers, baths or a pool to avoid heat exposure.  Learn where your heat tolerance temperature ranges are and stay within them.
  • Yoga and Tai Chi exercise have shown results for reduction of stress and thus fatigue.
  • Wear lightweight clothes.
  • Avoid caffeinated beverages as they may keep you awake resulting in more fatigue when you awaken.
  • Avoid alcohol.
  • Meditation and prayer.  Spiritual aspects of life can be very important in coping with multiple sclerosis stress and thus fatigue.

When you are seeking to modify your lifestyle or take medications, supplements or other significant changes make sure to discuss your planned modifications with your health care professionals to make certain that the changes will not impact your MS or other conditions in a negative fashion.  This is VERY important