Ms Subtype And Disability
MS subtype and disease severity can affect the risk of fatigue. The Expanded Disability Status Score correlates with fatigue scores,48,50,51 though less strongly, perhaps, after adjusting for depression.51,52 A review of The New York State Multiple Sclerosis Consortium Database showed that fatigue consistently correlated with Expanded Disability Status Score.47 Fatigue appears to be more severe in patients with progressive subtypes of MS,3,49 but this observation may in part be confounded by differences in disability levels.49
Tip : Limit Certain Drinks
Certain behaviors may seem to help with fatigue, but in the end, they may cause more problems than they solve.
Drinking a hot beverage may sound like a good way to wind down if youre having trouble sleeping, but coffee and tea typically contain caffeine.
Be sure to check whether your drink contains caffeine. It can prevent you from falling asleep, leading to fatigue the next day.
Similarly, while alcohol may help you feel sleepy after you first drink it, it can make it harder to get a restful nights sleep later.
Consider behaviors that may be contributing to poor sleep habits and fatigue and try to take steps to adjust them.
How Is Ms Fatigue Different To Ordinary Fatigue
MS fatigue is more than the tiredness that everybody feels after exertion or missing a good nights sleep. This type of tiredness can still affect you, but MS fatigue goes beyond that.
MS fatigue can be physical and mental it saps energy in an instant and can stop you from completing tasks. MS fatigue can be very debilitating and, unlike ordinary fatigue, it can take a long time to recover from.
MS fatigue is often overwhelming. It can happen at any time without warning or without any apparent reason. Some people say they experience MS fatigue after gentle activities such as writing or reading and they immediately need to rest.
Others say that MS fatigue happens after physical exertion, such as taking the dog for a walk or doing the shopping. For others, MS fatigue can happen after cognitive exertion such as working on the computer and completing mentally-demanding tasks. You may also experience MS fatigue when you wake up, in some cases every day, even after a good nights sleep.
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The Modified Fatigue Impact Scale
The Modified Fatigue Impact Scale, proposed by the Multiple Sclerosis Council for Clinical Practice Guidelines, has gained recognition among MS specialists as a reliable tool. Originally derived from the 40-item Fatigue Impact Scale ,59 the MFIS contains only 21 items and offers a more multidimensional assessment: physical , cognitive , and psychosocial functioning . The total score is the sum of the 21 items. An abbreviated version that contains 5 items also exists. Besides its multidimensional features, other advantages of the MFIS include ease of use, good reproducibility, and strong correlation with FSS results .51
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 Figure 1.
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What Are Symptoms Of Fatigue
There are two major types of fatigue in MS. These two types of fatigue are probably separate problems related to the MS.
The first type is a general feeling of tiredness. It may feel as if one has not slept the night before. This feeling may be worse in the afternoons or after activity. People may feel that they are unable to do as many tasks without getting tired as they did before.
A second type of fatigue is muscular. In this type, there is increased weakness after repeated activity. Often, this occurs with walking. People may find that they are dragging one leg or are more unsteady.
Axonal Loss And Altered Cerebral Activation
As conventional measures of T2 lesion volume and atrophy have fallen short in providing a basis for fatigue in MS,20 many investigators have relied on non-conventional neuroimaging techniques to shed further insight. The demonstration on positron emission tomography of decreased regional glucose metabolism in the frontal cortex and basal ganglia of fatigued MS patients has suggested that neuronal dysfunction in these regions may play a role.21 Magnetic resonance spectroscopy studies have shown significant reductions in N-acetylaspartate/creatine ratios in multiple brain regions among fatigued MS patients in comparison to non-fatigued MS patients, suggesting axonal loss as a contributing factor.22,23 MS-related fatigue also may arise at least in part from compensatory reorganization and increased brain recruitment, as functional MRI studies that have demonstrated increased volumes and patterns of activation in the cingulate gyri and left primary sensory cortex in fatigued MS patients compared to non-fatigued patients.24
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A Different Kind Of Tired
Before learning how to beat fatigue, its useful to understand the types of fatigue you may face when you have MS.
Researchers have started to identify a number of distinct characteristics specifically associated with MS. They define it as quite different from garden-variety tiredness:
- Onset: 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.
- Sensitivity to heat: Heat and humidity may aggravate it.
- Severity: It tends to be more severe than other types of fatigue.
- Effect on activities: Its more likely than regular fatigue to disrupt your ability to perform everyday tasks.
How To Manage Ms Fatigue
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.
MS fatigue often results from secondary factors, such as co-existing medical conditions, poor diet, lack of fitness or sleep, medication side effects, stress, depression, hormonal changes or heat sensitivity. Identifying any contributing factors, should help you to develop a tailored management plan.
Fatigue management strategies include:
- Stay active exercises to increase your stamina and strength may be useful.
- Monitor sleep patterns and address any issues.
- Manage other contributing MS symptoms, such as depression.
- Rest/take breaks.
- Vary heavy with lighter tasks for example, if you have more fatigue in the afternoon, do harder jobs in the morning.
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Medications Used To Treat Ms
Medications used for the treatment of fatigue can be helpful but are usually not the magic answer to curing fatigue.
Neurologists sometimes prescribe drugs such as the following to MS patients who need to manage fatigue:
Talk to your healthcare provider about whether one of these medications would be useful for you. It’s also important to understand that there are different strategies for taking these medications. It’s not an all or nothing deal.
For instance, a person with MS may only take their Provigil if they know they are going to have a long, grueling day. Another person may rely on daily Ritalin to manage fatigue.
These medications also have side effects, such as cardiovascular ones, which may not be safe for you.
Actions For This Page
- Multiple sclerosis is a disease of the central nervous system that can affect the brain, spinal cord and optic nerves.
- Common symptoms include fatigue, bladder and bowel problems, sexual problems, pain, cognitive and mood changes such as depression, muscular changes and visual changes.
- See your doctor for investigation and diagnosis of symptoms, since some symptoms can be caused by other illnesses.
- Whilst there is not yet a cure for MS, researchers are making promising progress and discoveries about the treatment and management of MS every day.
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Tips To Conserve Energy
Use Adaptive Aids.Reachers, dressing aids, and other adaptive equipment can significantly help conserve energy when dressing, bathing, and performing other household and personal activities. Many of these items may be obtained through MSAAs Equipment Distribution Program . Please visit mymsaa.org or call 532-7667 for more information.
Shop from Home.Rather than using valuable energy walking around stores, use catalogs or order items online. In addition to avoiding the crowds and exhaustion from walking through stores or malls, ordering clothes allows you to try them on at your leisure when your energy level is highest. Many grocery stores also offer online ordering with either free delivery or a minimal charge for delivery.
Take Fewer Steps.Try to take care of as many things as possible in one room to eliminate extra trips.
Consider Telecommuting.A great way to conserve energy is to reduce the amount of time spent traveling to and from work. Ask your employer about working part of the week from home.
Dont Get Overheated.This can cause fatigue. Wear your cooling vest or other cooling apparel and try to go outside either early in the morning or later in the evening, when temperatures are at their coolest.
The following medications, among others, are prescribed for depression. These have been found to help lessen fatigue in certain individuals. Antidepressants may need to be taken for several weeks before seeing an effect.
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.
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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.
How Is Fatigue Related To Multiple Sclerosis
Fatigue is the most common symptom of multiple sclerosis . It occurs in 75 percent to 95 percent of patients with MS. Fatigue can occur at all stages of the disease. The symptom is not related to the severity or to the duration of MS. At times, fatigue interferes with function and is an important symptom to manage. There are a variety of ways to combat fatigue in MS.
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Speech And Swallowing Changes With Ms
Speech and swallowing changes can occur due to affected nerves being damaged. This may present as changes to the voice tone and quality, or coughing when eating.
These symptoms should be reported to your MS healthcare team for assistance from a speech therapist, who can advise on appropriate management.
Is It Always Ms Fatigue
It is important to note that, even though this form of fatigue is characteristic to MS, it is possible for MS patients to experience other forms of fatigue. For various reasons, they may fail to get enough sleep at night and, if this is the case, they will be exhausted. Incontinence and the pain and discomfort associated with spasticity are examples of factors that might keep MS patients awake at night. Other factors that can cause MS patients to feel exhausted are the side effects of the medications they take. These could cause them to feel drowsy and exhausted, impairing their capacity to work and to think. MS patients may also suffer from medical conditions like anemia, which happen to be characterized by fatigue.
As fatigue in MS patients can be explained by more than one factor, the best course of action for MS patients who experience it is to consult their doctors. The doctors will help them determine whether it is multiple sclerosis fatigue or some other form or fatigue, and will subsequently prescribe the appropriate treatment.
P.S.I know what you may feel and think – “I am lost! I don’t have any chance to get cured etc” – I have heard this numerous times and I must tell you this: I have seen many multiple sclerosis sufferers get rid of their symptoms at my private clinic and online using my simple & natural method. I KNOW what I am talking about.Give yourself a chance and
What Can Be Done
If you think you may be struggling with chronic fatigue, it is important to discuss your symptoms with your healthcare provider. Symptoms that are particularly important to discuss include:
It is also important to tell your healthcare provider about the medications you are taking, including dietary supplements, natural remedies, and complementary treatments. Some medications can exaggerate the symptoms listed above. For example, stimulants , as well as corticosteroids, may cause sleep disturbances. Your healthcare provider can provide guidance on what medications and interventions may restore your sleep, as well as advice on medications to avoid.
It is also important to discuss chronic pain symptoms with your healthcare provider because chronic pain often leads to sleep difficulties, which in turn leads to chronic fatigue. Your healthcare provider may order laboratory tests to determine if organ involvement may be causing chronic fatigue.
For those with arthritis, maintaining a healthy weight and participating in regular exercise may also help reduce symptoms of chronic fatigue.
‘ms Fatigue’ Vs Feeling Fatigued
Life can get busy, so its natural to sometimes feel run down or exhausted. This can come from stress at home or at work, a poor diet and a lack of exercise, or even just a rough nights sleep.
The difference between feeling fatigued and MS fatigue is that MS fatigue doesnt go away with rest. MS fatigue can be chronic, ongoing and can make it harder to engage in work, life and daily tasks.
Were here to give you the information, support and services to help you manage MS fatigue and any other symptoms you may be experiencing.
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When Should I Be Concerned
It is important to remember that many different things can cause fatigue and/or anaemia, and more commonly it can be explained by lack of sleep, long hours at work, hormone imbalances, anxiety, depression or dietary deficiencies. However, for this reason, leukaemia can be hard to spot because the signs and symptoms are common to other unrelated problems. As a general rule, if your level of tiredness is affecting your ability to function properly and is persisting for an unusual length of time, visit your GP to gain professional opinion and rule out any underlying problem.
Knowing what other symptoms are typical of leukaemia is crucial for helping you make the decision to visit your GP sooner for a blood test. Connect the dots between the symptoms of leukaemia and spot leukaemia sooner.
For information on the other symptoms of leukaemia, click here.
Using Your Energy Wisely
You may need to think ahead as you budget your energy each day. This can be tricky, but once you get into the flow of your routine, conserving your energy can be a smart way to battle your fatigue. A few ways to best utilize your energy include:
- Building rest times into your schedule, like an afternoon 20-minute power nap
- Planning energy-draining activities for the morning when you are less fatigued
- Asking your family to take on more of the heavy-duty household chores
- Using your scooter or wheelchair to get around throughout the day
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Sexual Function And Ms
Sexual dysfunction is common in MS. It can be directly related to MS from brain or spinal cord lesions, or more indirectly related due to other MS symptoms such as depression and fatigue, or from wider relationship and social issues stemming from MS.
Although a difficult area to talk to your health professional about, it is an important area to maintain your quality of life and self-confidence. There are many avenues of help available from physical to psychological and your GP, MS nurse or neurologist can point you in the right direction for the most appropriate assessment and assistance.
Cognitive And Psychological Interventions
Several studies have investigated cognitive training in pwMS aiming mainly to improve attentional deficits, communication, and memory . Overall evidence for beneficial effects of psychological interventions in management of fatigue in pwMS is scarce. A systematic review reported that cognitive behavioral approaches were beneficial in the treatment of depression and in helping people adjust to, and cope with having MS . However, the authors did not find any studies focusing on psychological approaches to managing fatigue in pwMS. Findings from a few studies evaluating fatigue as a secondary outcome showed inconclusive and/or non-significant improvements in fatigue management .
A recent RCT showed that an internet-based cognitive behavior therapy program MS Invigor8 was an effective treatment for MS-related fatigue . The CBT included eight tailored, interactive sessions with a clinical psychologist over 810 weeks. The treatment group reported significantly greater improvements in fatigue severity and impact as well as in anxiety, depression and quality-adjusted life years . Another RCT showed significantly greater improvements in fatigue in pwMS after eight weekly sessions of CBT compared to relaxation therapy . However, both groups showed clinically significant decreases in fatigue. ESs for reduction in fatigue from baseline to the end of treatment were 3.03 for the CBT group across the 8 months compared with the relaxation therapy group .
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