Fatigue In Daily Life Primary Care And Depression
Fatigue is a common complaint, not only from medical and psychiatric patients but also in the community. In the mid 20th century, a study seeking cancer-predicting signs interviewed over one million people in the US and found that 45.7 percent of women and 33.0 percent of men reported fatigue. National mental health surveys in several countries agree on its high prevalence rate. The 1984 Epidemiological Catchment Area study of the National Institutes of Health reflected a current fatigue prevalence of 6.7 percent and a lifetime prevalence of 24.4 percent in a study of the Australian Bureau of Statistics, 13.29 percent reported fatigue in a survey conducted in Great Britain by the Office of Population Censuses and Surveys, fatigue was the most common neurotic symptom with a prevalence of 27 percent. Most of these people associate their fatigue with a psychological component. In a British study of over 15,000 people in the community, almost 60 percent attributed their fatigue to psychosocial or psychological causes.
Fatigue is also a common complaint in primary care. Studies in primary care in North America and Europe show that 10 to 20 percent of men and 10 to 30 percent of women report significant fatigue.â The World Health Organization Multinational Primary Care Study, which was conducted in industrialized and underdeveloped countries, shows a weighted prevalence of eight percent for substantial unexplained fatigue vs. 1.7 percent for CFS.
Take Rest When You Need It
For some people, rest helps relieve fatigue and is an important part of fatigue management. Resting can prevent you getting to a point of complete exhaustion and coming to a sudden halt, mid task.
A few small breaks are best for some people or you might feel better after just one longer rest at a particular time.
For example:
- try taking a few short rests or power naps,
- through the day try just one longer rest,
- at the same time each day take a break between coming home from work and getting ready for an evening out
When you rest, try to make your rest as complete as possible. Doing smaller jobs around the house, talking to the family or watching TV might be more relaxing than work or chores, but it is not really resting. It can be tricky, but the aim should be to switch off both the mind and the body.
You might want to have a short sleep, or use relaxing music to help you clear your mind. Some people find yoga, mindfulness or meditation useful.
If worries disturb time set aside for rest, try writing down these concerns and ‘shelving’ them while you are resting. You will have more energy to tackle them once your energy levels are up again.
If resting helps you manage your fatigue, it is important that other people realise how valuable this quiet, undisturbed time is.
Above all don’t feel guilty about taking rest when you need it. If this is something you find challenging our online fatigue management course can help you think it through.
What If Oral Medications Wont Work For Me
Since Tecfidera did not work for me, my neurologist sent me to an MS specialist who then put me on Ocrevus, an infused medication. While I did not have any new lesions while on this medication, I found myself fatigued, in a lot of pain, and bedridden for the six months between infusions. I can only share my experience.
As you know, MS is different for every person. The same holds true for the medications. Many people swear by Ocrevus and have shown major improvement while on it. I felt better once it left my system, so I swore off medications for a little over a year.
My most recent trial was Tysabri, an infused cousin to Ocrevus. Ive been taking it for almost one year. It took about six infusions for my body to adjust, but after that time, it was okay. Other infusion medications for MS include Lemtrada and Novantrone.
Some choose the oral route because its easier and much less time consuming than sitting at a hospital for hours hooked up to an IV for an infusion. I have no experience with the next type of medication, self-injectables, but I have heard and read mixed reviews.
If you choose a self-injectable treatment, there are some tips Ive found to help make you more comfortable :
- Rotate your injection site to protect your skin
- Take treatment as prescribed
Always remember to talk to your doctor or healthcare professional about how to exercises or other resources to help minimize your pain and help you feel more comfortable.
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A Diagnostic Approach To Fatigue
An open ended question, followed by a series of more focused inquiries will often prove to be a productive approach. This should be followed by screening for other confounding conditions such as sleep disorders or depression. A systematic approach to the assessment and treatment of fatigue in patients with MS is summarized in .
Evidence For Pharmacological Interventions For Fatigue In Persons With Ms
Currently, different pharmacological agents are used for treatment for fatigue in pwMS, which include amantadine, modafinil, and pemoline . Modafinil, a wake promoting agent that selectively works in the hypothalamic pathways used in narcolepsy, has been reported to improve fatigue in progressive MS . The efficacy of pemoline, a CNS stimulant, is still unclear . Amino pyridines and amantadine have been trialed however, systematic reviews failed to find evidence for efficacy or safety for their use . There is empirical support for use of antidepressants in MS-related fatigue, as depression is considered to be one of the major contributing factors .
One comprehensive systematic review exploring efficacy of different pharmacological treatments on non-specific fatigue in palliative care included 10 studies investigating amantadine , pemoline, and modafinil in pwMS . The authors reported mixed results with weak and inconclusive data. Amantadine was found to demonstrate some improvement in fatigue in pwMS . Both pemoline and modafinil failed to demonstrate a significant effect for management of fatigue in pwMS .
Commonly used pharmacological agents for fatigue and MS are summarized in Table 3, along with indications, doses, and side effects.
Table 3. Commonly used pharmacologic treatments for MS-related fatigue.
Summary
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Treatment For Ms Relapses
Contact your specialist MS nurse or GP if you think you’re having a relapse.
A flare-up of symptoms can sometimes be caused by something other than a relapse, such as an infection, so your nurse or GP needs to check for other possible causes.
Treatment for a relapse usually involves either:
- a 5-day course of steroid tablets taken at home
- injections of steroid medicine given in hospital for 3 to 5 days
Steroids can help speed up your recovery from a relapse, but they don’t prevent further relapses or stop MS getting worse over time.
They’re only given for a short period of time to avoid possible steroid side effects, such as osteoporosis , weight gain and diabetes, although some people will still experience problems.
Not using steroids more than 3 times a year will also help to reduce the risk of side effects.
What Does It Mean For A Fatigue Medication To Work
Now do keep in mind, this is all based on my own experience with these medications. I am 100% sure that not everyone will totally agree with everything I have to say because we are all different. I’ve said it a million times before and I’ll say it at least a million more times what works for one doesn’t work for all. If it did, we probably wouldn’t have such a large assortment of medications to choose from. As well, if you are thinking about starting one of these medications for the first time , I think it’s important to start one with the right expectations. Ask yourself, what does it mean for a fatigue medication to “work”?
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What Else Can I Do To Manage These Symptoms
It can be useful to learn to recognise the early signs of fatigue and how it affects you. Likewise, talking with family, friends and/or colleagues may help them understand any limitations. Identifying any contributing factors to your MS fatigue, can help you develop a tailored management plan with your healthcare professional. Recent research is strongly supporting the role of exercise in managing fatigue. Even though it may seem counterproductive to exercise when feeling so tired, it can be a very effective management tool for many, and of course has other benefits towards health and wellbeing.
Fatigue management strategies include:
- Maintain a well-balanced diet to increase energy levels.
- Stay hydrated.
- Stay active low or no activity can increase fatigue, and regularly used muscles help to provide energy to accomplish tasks.
- Monitor sleep patterns and address any issues.
- Manage other contributing MS mental health symptoms, such as depression, anxiety or stress.
- Rest and take time to relax to decrease muscle tension and ease stress.
- Vary heavy with lighter tasks for example, if you have more fatigue in the afternoon, do harder jobs in the morning. Or prioritise those jobs which need to be done before others.
- Manage any heat sensitivity. Even the smallest increase in temperature can increase a persons fatigue. Like MS fatigue and the need to rest and recover, your body needs to cool down if affected by heat and humidity. Read more about heat sensitivity and MS here.
Ms Medication Side Effects To Be Aware Of
All MS medications come with the risk of side effects. Most of the effects are flu-like symptoms. Others include:
- Joint pain
- Needle fatigue
- Low white blood cell count
There are more that are specific to each medication. Make sure you do any necessary research so that you can make an informed decision with your doctor.
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Organise Your Living And Work Spaces
You might find there are practical changes that can be made to the places you work and live. Maybe re-organising desks or cupboards, or adjusting the temperature or lighting to suit you better.
Sometimes, the simplest of changes can make the workplace or home more energy efficient for you.
An occupational therapist can help you assess the spaces you use at work and at home – and may suggest adaptations or equipment that could help. For more information about the support that occupational therapists can offer, and how to find one, download or order our leaflet Occupational therapy and MS.
Ms Subtype And Disability
MS subtype and disease severity can affect the risk of fatigue. The Expanded Disability Status Score correlates with fatigue scores,,, though less strongly, perhaps, after adjusting for depression., A review of The New York State Multiple Sclerosis Consortium Database showed that fatigue consistently correlated with Expanded Disability Status Score. Fatigue appears to be more severe in patients with progressive subtypes of MS,, but this observation may in part be confounded by differences in disability levels.
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What Does It Feel Like
Not everyone experiences fatigue the same way, and the feeling can be difficult to explain to others. In general, there are two types of MS fatigue: a general feeling of extreme tiredness and muscular fatigue.
MS fatigue is different from regular tiredness. Some people with MS describe the fatigue as feeling like youre weighed down and like every movement is difficult or clumsy. Others may describe it as an extreme jet lag or a hangover that wont go away.
For others, fatigue is more mental. The brain goes fuzzy, and it becomes difficult to think clearly. Fatigue may affect the eyesight, as well as your ability to speak without slurring your words.
MS fatigue is also distinguished by the following characteristics:
- occurs on a daily basis
- often occurs in the morning even after a good night of sleep
- tends to worsen as the day progresses
- is aggravated by heat and humidity
- may come on suddenly
People with MS fatigue may need to recharge their batteries with frequent rest and a short daily nap, but its also possible to plan and schedule your daily activities to help conserve energy.
To conserve energy, try these tips:
While conserving energy is important, too much rest can be counterproductive. Exercising daily is essential for maintaining muscle strength and building endurance. Try these exercises and activities for MS.
There are several other lifestyle changes and remedies that can help you battle fatigue. These include:
Muscle Spasms And Stiffness
Muscle spasms and stiffness can be improved with physiotherapy.
Techniques like stretching exercises can help if your movement is restricted.
If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles.
This will usually be either baclofen or gabapentin, although there are alternative medicines, such as tizanidine, diazepam, clonazepam and dantrolene.
These medicines all have side effects, such as dizziness, weakness, nausea and diarrhoea, so discuss which of these would be best for you with your specialist MS nurse or GP.
If these medicines are not effective, you may be offered a 4-week trial of nabiximols . This is a cannabis-based medicine sprayed into the mouth. Read about medical cannabis.
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Finding Help And Taking Help That’s Offered
People might say to you ‘If theres anything you need…’ or ‘If there’s anything I can do…’, but it is not always easy to ask for help, even when it is offered.
It can be useful to prepare a list of tasks that youd like help with. That way, if someone does offer to help, you can easily tell them how they could help.
If you find it hard to take, or ask for help, our fatigue management course could help you!
Tip : Manage Your Medications
If youre taking medications for other symptoms, check their side effects to make sure they arent adding to your fatigue.
Talk to your doctor about each medication you take and work together to determine whether you can stop taking those that can cause fatigue.
In terms of medication to help ease fatigue, your doctor can help you decide whats right for you.
While some medications can help with fatigue management, the Cleveland Clinic advises against using medications to treat tiredness.
This is because you may already be taking other medications for your MS, and its best to limit the number of drugs you take when possible.
However, everyones MS symptoms are different. If you try the tips in this article and nothing works, there are medication options to help reduce fatigue.
They include amantadine and modafinil , two drugs used off-label.
Theyre still being studied as a treatment for MS fatigue, which means your insurance may not cover them for this purpose. For more information about these drugs, talk to your doctor.
OFF-LABEL DRUG USE
Off-label drug use means a drug thats FDA approved for one purpose is used for a different purpose that it hasnt yet been approved to treat.
However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients.
So, your doctor can prescribe a drug however they think is best for your care.
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The Top 15 Supplements For Natural Ms Treatment
In a recent podcast, I made the case for natural treatment of multiple sclerosis with diet, supplements, and other innovative therapies. My experience while treating MS patients for over thirty years has convinced me that while drugs have limited benefits , natural therapies have a dramatic impact on the course of MS.
Before we get to supplements, lets talk diet. MS is actually the subject of the longest clinical trial of a dietary intervention to treat a medical condition. Beginning in 1949, Dr. Roy Swank treated a group of MS patients with a modified low-fat diet. Whole milk, cheese, butter, margarine and all sources of trans-fats were prohibited. The diet was supplemented with one tablespoon of cod liver oil per day, and participants were encouraged to consume fish three times per week.
After 34 years of follow-upunprecedented in nutritional sciencethere were dramatic reductions in disability compared to a control group on an indiscriminate diet. Fifteen patients adhered to the diet for 50 years thirteen remained active and free of limitations, while only two needed assistance to walk.
She recently obtained a seven-figure grant to undertake a comparative study of the Swank Diet vs. the Wahls Protocol for MS patients at the University of Iowa. My personal preference is for the Paleo Diet that Ive been using with good results for many years with my MS patients.
When it comes to supplements, here are the ones with the most scientific mojo:
How Your Doctor Can Help
You need to let your doctor know all about your fatigue symptoms. This can help them see the patterns in your day-to-day life.
âDonât just say âI’m fatigued,ââ Hou says. âExplain what that actually means, like âI’m fatigued and therefore I can’t finish showering,’ or ‘I avoid showering because itâs too tiring.â Tell us if you canât finish vacuuming, or have to take a nap at two o’clock every day.â
Once theyâve gathered this info, they can help you come up with a plan. They might suggest that you:
Above all, reach out. Talk to your doctor, your loved ones, and others with MS for connection and help with your fatigue.
âAs with everything MS, having a good support system is of great importance,â Serra says. âRecognizing that fatigue is a common and disabling symptom in MS, and that you are not alone in experiencing it, is a good first step.â
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