How To Reduce Fatigue In Ms

Ruling Out Or Resolving Non

People with MS can experience fatigue unrelated to the disease. To identify potential non-MS reasons for fatigue, your doctor may take steps including:

• Blood tests, to rule out thyroid issues, anemia and other conditions possibly affecting energy level and sleep
• Screening for sleep quality, to identify issues such as obstructive sleep apnea and anxiety, which can interrupt sleep
• Checking for infections, which may manifest as fatigue

Selection Criteria For Articles

Articles with the following characteristics were selected for meta-analysis: 1) original research articles 2) clinical trial studies 3) full text articles and reports 4) studies examining the relationship between exercise and fatigue in MS patients, and articles published in Persian with English abstract and English .

Management Of Fatigue In Persons With Multiple Sclerosis

• 1Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
• 2The University of Melbourne, Melbourne, VIC, Australia
• 3School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

Fatigue is one of the most common symptoms of multiple sclerosis. Despite advances in pharmacological and non-pharmacological treatment, fatigue continues to be the disabling symptom in persons with MS , affecting almost 80% of pwMS. In current practice, both pharmacological and non-pharmacological interventions are used in combination, encompassing a multi-disciplinary approach. The body of research investigating the effect of these interventions is growing. This review systematically evaluated the existing evidence on the effectiveness and safety of different interventions currently applied for the management of fatigue in person with multiple sclerosis in improving patient outcomes, to guide treating clinicians.

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Exercise Can Boost Energy

Certain types of easy exercise, such as gardening and yoga , have been shown to boost energy levels, reduce stress, improve joint range of motion, help manage spasticity, and increase strength. Because of its natural buoyancy, water allows many men and women with MS to perform exercises they cannot do outside of the pool. Water exercise helps increase flexibility, strengthen the upper and lower extremities and trunk, improve ambulatory skills, increase coordination and balance, and condition the overall body to raise endurance levels and lessen fatigue.

For more information on the benefits of aquatic therapy and aquatic exercise for individuals with MS, please visit MSAAs online aquatic center.

Get Help For Depression

If you are feeling down and hopeless, or if things that used to be enjoyable dont interest you anymore, you may be depressed. Depression is one of the most common symptoms of MS, and left untreated, it can make your fatigue worse.

Depression is treatable, so if you think you might be depressed, tell your healthcare provider right away.

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Take Breaks And Pace Yourself

Pacing yourself and taking breaks during the day can help you stay healthy, says Wentink.

When Im drained and continue to push, I think Im putting myself at risk for getting sick, he says. When I feel fatigued, I take it as a sign that I need to step back and take a break.”

Symptoms tend to get worse when severe fatigue sets in, says Wentink. I try to slow down before that happens because I dont want to bring on a relapse, he adds.

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 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.

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What Is The Research Team Doing

The research team is recruiting patients in southeastern Michigan and Seattle, Washington, who have problems with fatigue from MS. The team is assigning patients to one of three treatment groups by chance: CBT by phone with a therapist, modafinil, or a combination of both. The CBT treatment includes eight weekly telephone calls to help patients manage fatigue, followed by two check-in calls from a therapist the following month. The CBT addresses issues such as setting goals, improving sleep, and conserving energy. On the follow-up calls, patients make plans for managing fatigue in the future.

At the start of the study, over the 12-week treatment period, and 12 weeks after treatment ends, the research team is asking patients about their fatigue, other MS symptoms, sleep, social functioning, and quality of life. Study participants wear a sensor around their wrists to track their physical activity.

Across the three treatment groups, the team is comparing patients levels of fatigue, how well they follow their treatment plan, and any side effects. The team is also comparing how well the treatments work for patients with MS who have other conditions, such as depression, sleep problems, a disability.

Patients with MS, their providers, payers, and national and regional MS organizations are helping to design the study and recruit participants.

Medications To Treat Ms Fatigue

There are several types of medications that are sometimes prescribed to help manage fatigue in people with multiple sclerosis. Members of MyMSTeam report varying degrees of effectiveness. Like all medications, drugs prescribed for MS fatigue can also cause side effects.

More than 2,400 members of MyMSTeam indicate that they have taken Symmetrel . Amantadine is used to treat influenza and Parkinsons disease, and researchers are unsure how it works to manage MS fatigue. Provigil is a wakefulness-promoting drug often prescribed for those with narcolepsy. Nuvigil is a very similar medication that is usually taken once a day.

Stimulants like Adderall , Ritalin , and Concerta can also be used to treat MS fatigue although there is not good evidence that these work long-term.

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Behavioral And Educational Interventions

Several published reviews and studies have examined the effectiveness of various types of behavioral and/or educational interventions for management of fatigue in pwMS, which included group fatigue management programs, energy conservation programs, and psychotherapies . A meta-analysis investigated overall effectiveness of different types of educational programs on reducing the impact or severity of self-reported fatigue in pwMS . The authors included eight RCTs, involving 662 pwMS. Educational interventions included a fatigue management program, energy conservation programs, mindfulness interventions, and CBT. The authors found significant global improvement with a large pooled treatment ES for the educational interventions of 0.54 .

What Does Ms Fatigue Feel Like

Members of MyMSTeam describe chronic, profound fatigue that does not usually improve with a nap or a cup of coffee. Here are some descriptions of MS fatigue from members in their own words:

• My body just shuts down.
• Utter weariness.
• Like taking three sleeping pills and still trying to function normally.
• My brain and body just stop working.
• I’ll crawl at times, sit on the floor, then I can get up and take a few more steps.
• Bone-crushing fatigue.
• Fatigue is a never-ending battle.

MyMSTeam members also discuss how MS fatigue affects their relationships with friends, family, and romantic partners. Members describe disappointment and resentment from loved ones who do not understand how severe and unrelenting their fatigue from multiple sclerosis can be.

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Tip : Regulate Your Sleep

Sleep problems are often behind the fatigue that people with MS experience.

Whether you have trouble falling asleep, staying asleep, or getting the amount and type of sleep you need to awaken feeling refreshed, the result is the same: You feel tired.

To help prevent these problems, its important to regulate your sleep. This might involve identifying and treating other MS symptoms that cause sleep problems for example, urinary dysfunction.

If all else fails, you can talk with your doctor about using sleep medications for a short period of time.

Are There Supplements That May Be Useful In The Prevention Of Attacks

Note: Please refer to the Passport to Whole Health, Chapter 15 on Dietary Supplements for more information about how to determine whether or not a specific supplement is appropriate for a given individual. Supplements are not regulated with the same degree of oversight as medications, and it is important that clinicians keep this in mind. Products vary greatly in terms of accuracy of labeling, presence of adulterants, and the legitimacy of claims made by the manufacturer.

The use of dietary supplements in MS can be an overwhelming topic. Supplement options may include those that are intended to modify the disease process, as well as those intended to treat specific MS-related symptoms. This section focuses on supplements with potential disease-modifying properties.

There are several challenges in determining appropriate supplements to use in MS. First, the potential options are numerous. Second, the majority of trials on supplements are small or based on experimental models of MS in animals. It is usually premature to draw definitive conclusions from these types of studies. Lastly, many supplements have theoretical effects on the immune system. Some experts in the field recommend avoiding anything that is potentially stimulating to the immune system. This issue is addressed in more detail below.

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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 Causes Ms And Ms Fatigue

Its unclear why someone develops multiple sclerosis . Its not linked to any specific health practice, and its unclear whether it is avoidable. So far, research reveals that a mix of hereditary and environmental variables contribute to the cause.

MS fatigue is among the most unpleasant symptoms of the disease. MS fatigue may be distressing, and it can interfere with job and family life, mental and physical health, and social and recreational activities for some people. Fatigue can be a major symptom of the active inflammatory disorder, or it can be a secondary sign of other medical disorders.

So what exactly causes this fatigue? Cytokines are a large group of tiny proteins that play a key role in cell signalling. The central nervous system interacts with inflammatory cytokines, neurons, and cells. Cell signals in these sensory neurons can cause fatigue and discomfort. However, a changed neuroendocrine system may be able to control inflammation and excessive stimulation.

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How To Treat It

If youre experiencing fatigue, make an appointment with your doctor to discuss possible treatment options. A doctor will likely want to run some tests to find out more about what may be causing your fatigue.

Based on the results of these tests, your doctor may prescribe medications or recommend counseling, physical therapy, and occupational therapy.

Relieving Fatigue Through Cooling

Research has shown that nerves with damaged myelin are sensitive to changes in temperature. A rise in temperature may cause nerve conduction to be less efficient, whereas a reduction in temperature may allow more signals to be transmitted across a damaged nerve.

The idea of cooling people with MS to alleviate symptoms has been researched and practiced for many years, but practical methods of cooling an individual had not been perfected until the 1990s. At this time, MSAA and NASA joined forces to develop and test a cool suit.

Cooling someone too quickly such as taking cold baths or sitting close to the air conditioner can cause shivering and vasoconstriction. This reaction does not help to alleviate MS symptoms. By slowly cooling down the body, an individual with MS may experience improvement in areas of physical performance, cognitive processing, and motor function. Cooling also significantly reduces fatigue, helping a person with MS perform his or her daily activities.

Controlled cooling is now achieved through passive cooling garments. These are portable and allow the wearer to enjoy symptom relief indoors or out. Passive cooling garments, such as a vest and wraps for the neck, wrists, or ankles, use ice or gel packs to give people with MS immediate and simple relief from heat and certain MS symptoms. Some passive garments are dampened and chilled before use.

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How Do You Overcome Ms Fatigue

10 ways to manage MS fatigue

Recognize And Manage Depression

Depression can be a major problem in MS. And depression often contributes to fatigue. Symptoms include changes in appetite or sleep, irritability, and a feeling of hopelessness or guilt.

Make sure to discuss your depression with your healthcare provider because it is treatable. Counseling and medication can help your depression and may alleviate your depression-induced fatigue as well.

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Clinical Significance Of Fatigue Changes

Of the outcome measures reported, MCID has been determined only for the FIS in MS populations. When anchored to measures of health-related quality of life, FIS demonstrates an MCID of 10 to 20 points.42 Of the two included studies that used the FIS, both reported significant improvements in fatigue after the intervention . However, although the mean change in FIS scores recorded by both studies is within the range of MCID estimates reported for the FIS, both studies reported large SDs, suggesting that these interventions may be clinically significant for only some participants.

How Ritalin Makes Me Feel

Ritalin is a little different for me. While Nuvigil definitely promotes wakefulness, Ritalin does precisely what I would have expected a stimulant to do. When I take Ritalin, its like my brain is ticking a little faster. I feel like I drank 10 cups of coffee, and I can think a bit more clearly, but it doesnt last long. Maybe a few hours? And if I only take one pill, those few hours are often followed by a huge crash, which can render me more fatigued than I was in the first place. It doesnt seem like everyone deals with that crash, but Im not everyone, Im me. Again, everyone is different. Either way, my point is, it works, which again, I would define as giving me the strength to carry the crushing weight of fatigue and not as eliminating the weight of fatigue.

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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: