Fatigue or low energy is a common symptom of multiple sclerosis (MS). Traditional MS treatment, self-care, and complementary management strategies may help boost your energy and feel less tired.
Multiple sclerosis (MS) involves symptoms like muscle weakness, numbness, and pain. Fatigue and low energy are also common.
Although there’s no consensus, fatigue is often defined as extreme tiredness or unrelenting exhaustion. It may involve both mental and physical symptoms.
The fatigue associated with MS can be difficult to cope with and also challenging to explain to others, but it’s very real for those living with the condition.
Treatment for MS can help you manage fatigue. It may take the right combination of medications, lifestyle changes, and energy-saving tips.
Not everyone experiences MS fatigue in the same way or with the same intensity, and explaining how it feels to others may be difficult.
In general, there may be a general feeling of extreme tiredness and low energy as well as muscular fatigue.
MS fatigue is different from regular tiredness in that it’s usually not associated with physical or mental exertion or lack of sleep.
Some people with MS may describe it as feeling weighed down and like every movement is difficult or clumsy. Others may describe it as extreme jet lag or a hangover-type of feeling that won’t go away or improve with rest. Mental fatigue may be described as brain fog or difficulty thinking clearly.
Characteristics of MS fatigue may include:
- daily or frequent occurrence
- worsening as the day progresses
- intensification with heat and humidity
- sudden onset without much activity involved
- interference with daily tasks, even those that may not require much energy
You may also feel fatigued in the morning even after a good night’s sleep. Rest typically doesn’t improve MS fatigue.
Fatigue is difficult to explain or quantify. This is why doctors have developed the Modified Fatigue Impact Scale (MFIS). The scale can help evaluate how much you feel fatigue affects your life.
The MFIS takes up to 10 minutes to fill out. A healthcare professional may help you with this and explain in more detail what the scale is used for.
MFIS includes a series of questions or statements about your physical, cognitive, and emotional health. You’ll be asked to rate how strongly each statement reflects your experiences over the last month on a scale of 0 to 4, with 0 being “never” and 4 being “almost always.”
Examples of statements you’ll be asked to rate include:
- My muscles feel weak.
- I have to pace myself in my physical activities.
- I have trouble concentrating.
- I have been less motivated to participate in social activities.
You can find all of the questions and statements on the MFIS
The sum of all your ratings is your MFIS score. A higher score means fatigue is significantly impacting your day-to-day life. The score can help you and a healthcare team come up with a management plan that addresses your particular fatigue symptoms.
Nearly 80% of people diagnosed with MS experience fatigue at some point. Its cause isn’t yet clear. Different mechanisms may underlie the symptom, including structural brain and nerve damage, chronic inflammation, and immune system activation.
Sleep disturbances and medication side effects could also contribute to MS fatigue. If you have anxiety or depression, you may also experience low energy and lack of motivation, as these are common symptoms of those conditions.
Fatigue may also result from trying to compensate for the muscle weakness associated with MS.
Certain complications of MS may induce fatigue as well. This may be referred to as a secondary cause.
Complications and comorbidities (conditions that commonly co-occur) of MS that may increase low energy and exhaustion may include:
- chronic and severe pain
- iron-deficiency anemia
- difficulty moving, which may reduce physical fitness
- reduced thyroid function
- sleeping disturbances, such as insomnia, sleep apnea, or restless leg syndrome
- diabetes
- bacterial and viral infections
- anxiety and depression
- overweight or obesity
If you have MS fatigue, you may need to recharge with frequent and extensive rest and short naps throughout the day. Planning and scheduling your daily activities in a specific way may also help conserve energy.
These tips may help with energy conservation:
- Try to divide large or complex projects and tasks into smaller parts, pausing between each.
- Consider gathering supplies in advance of an activity, like cooking or cleaning, so you don’t have to run last-minute errands.
- Having your groceries and other supplies delivered may also help you spend your energy on other pressing tasks.
- Contemplate cooking all your meals for the week at once, if possible.
- Try to organize your house and office in a way that commonly used items are stored in easy-to-reach places.
- Using wheeled carts to transport heavier items around the house may be a good idea.
- Consider using adaptive devices for dressing, bathing, and household chores.
- If your fatigue tends to get worse when it’s warm and humid, you may want to use climate control technology or appliances, if possible.
While conserving energy is important, too much rest can be counterproductive. Exercising daily is essential for maintaining muscle strength and building endurance.
Other lifestyle changes and remedies can help you manage MS fatigue. These may include:
- going to physical therapy to learn about ways to conserve your energy and establish an exercise routine
- meeting with an occupational therapist to simplify tasks at work or at home
- practicing good sleep hygiene
- seeking mental health counseling to manage troubling thoughts, anxiety, and depression
- reducing alcohol consumption
- eating a balanced diet high in fruits, vegetables, whole grains, healthy fats, and lean protein
- avoiding certain foods that take longer to digest
A 2016 study also found that people with MS who followed a low fat, plant-based diet had a significant improvement in fatigue after 12 months.
Managing stress with yoga, meditation, and tai chi may also help.
Managing fatigue is part of the comprehensive treatment for MS. While there’s no cure for MS, treatments may help improve or slow down the progression of your symptoms, including low energy and exhaustion.
A healthcare professional may prescribe these medications to manage fatigue specifically:
- amantadine (Gocovri), an antiviral drug that seems to help with MS fatigue. Its mechanism for treating fatigue, however, is unknown.
- armodafinil (Nuvigil) or modafinil (Provigil), used to treat narcolepsy. These medications promote wakefulness in people with MS fatigue and may also help with sleep challenges.
- amphetamine-dextroamphetamine (Adderall), used as a stimulant that may improve your ability to focus
Depending on other symptoms and conditions you may have, a doctor may also prescribe:
- iron supplements for anemia
- sleeping pills to treat insomnia, such as zolpidem (Ambien)
- multivitamins for nutritional deficiencies
- thyroid hormone therapy
- antidepressants like fluoxetine (Prozac) or bupropion (Wellbutrin)
- medications to help with leg spasticity
- medications for urinary dysfunction, if the need to use the bathroom is keeping you up at night
- methylphenidate (Ritalin) or dextroamphetamine (Dexedrine) to improve wakefulness and increase energy.
- anti-inflammatory pain medications, like aspirin. A 2012 study found that taking 100 milligrams of aspirin twice per day significantly reduced MS-related fatigue.
Because fatigue may sometimes be a side effect of some medications, a doctor may also contemplate switching your dose or brand to see if your symptom improves.
Fatigue is a common symptom of MS and may greatly affect your quality of life.
Self-care, stress management, physical therapy, a nutrient-dense diet, and conserving energy may help you cope with MS fatigue.
Treatment for MS includes a combination of medications that aim to slow down the progression of MS. Sometimes, doctors may prefer prescribing additional medications that target fatigue specifically or that help you manage associated symptoms and conditions.