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Medically reviewed and verified by Kate Burke, MD, MHA
Fatigue is a common symptom for people with multiple sclerosis. According to the National Multiple Sclerosis Society, “over 80% of people living with MS suffer from some form of fatigue.” It can impede an individual’s daily life and make it hard to function at work or at home. Non-relapsing secondary progressive multiple sclerosis (nrSPMS) is a stage of MS where the disease generally worsens without relapses. Unlike relapsing-remitting MS (RRMS), which has periods of symptom flare-ups followed by recovery, nrSPMS sees a gradual decline in function over time. This progression can make symptoms like fatigue more severe! What can you do to combat fatigue?
MS Fatigue
Lassitude is a kind of fatigue specific to individuals with Multiple Sclerosis. The National Multiple Sclerosis Society states that it is different from other types of fatigue in that it
- Occurs most days
- Can start in the morning time
- Worsens as the day goes on
- Worsens in heat or humid climates
- Comes frequently and suddenly
- Is generally more severe than normal fatigue
- Is more likely to interfere with daily responsibilities
- Requires more recovery time
- Lasts longer
MS related fatigue has yet to be definitively linked to a specific part of the condition. Whether it is mental or physical impairments, fatigue seems to be a consistent and persistent side effect of having MS in general.
Research shows that individuals with nrSPMS are significantly more likely to experience fatigue than those with RRMS. In a study of patients over five years, 91% of those who transitioned to nrSPMS reported fatigue, compared to 68% of those who remained in the relapsing-remitting stage. This may be because of more nerve damage and a decline in the brain’s ability to compensate for lost function. Limited mobility, muscle weakness, and sleep disturbances are also more common in progressive MS. These can make fatigue even worse.
Bias Around Symptoms
It is common for people with MS to experience some misunderstanding from family, friends, or peers. People often assume that symptoms of MS, especially fatigue, are not a legitimate part of the condition. For those who do not understand fatigue, it is not for lack of trying or due to depression, but rather a physical symptom of the disease and it can be a serious one. There are various types of fatigue one might experience with MS including muscle spasms, bladder issues, extreme exhaustion, or “MS Fatigue” specifically.
Treatments for MS Fatigue
There are various types of rehabilitative therapies that can help to mitigate symptoms of MS fatigue. These include:
- Occupational therapy which is a form of therapy for those recuperating from physical or mental illness that encourages rehabilitation through the performance of activities required in daily life.
- Physical therapy to improve short term endurance and strength.
- Sleep regulation or a sleep schedule because sleep helps you think more clearly, have quicker reflexes and focus better.
- Psychological interventions or therapy to combat the depressive symptoms that might result from chronic fatigue.
- Heat management, to help keep your body temperature down and make your fatigue symptoms less severe.
Compared to other forms of MS, fatigue in nrSPMS is often more constant and less responsive to treatments. This is true even for treatments that work for relapsing forms of the disease. People with nrSPMS may find that their energy levels do not recover as easily. This makes it harder for them to keep up with daily activities. While there is no cure for MS fatigue, treatment options like physical therapy, energy conservation strategies, and certain medications may help manage symptoms and improve quality of life.
There are no medications approved by the FDA for the treatment of MS fatigue. Commonly used off-label symptomatic MS fatigue medications are amantadine and modafinil. However, while these medications are commonly prescribed, their efficacy remains uncertain. If you notice an increase in fatigue-like symptoms, talk to a medical provider immediately to get the help you need to feel better.
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