Fatigue: Multiple Sclerosis (MS) Symptom

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More than just being tired, fatigue is a constant and ongoing lack of energy. And, it’s a major symptom of multiple sclerosis.

Fatigue is not simply feeling tired all day. Scientists are still trying to understand the complexities of MS fatigue, but they have discovered that there are different types of fatigue. People can, and do, suffer from both kinds simultaneously.

  1. Primary fatigue
    • Caused by how the brain functions in people with multiple sclerosis
  2. Secondary fatigue
    • Caused by other factors related to multiple sclerosis including medication side effects and sleep problems


Fatigue is a very common symptom and one of the first signs of MS. Unfortunately, fatigue can also be the most debilitating symptom. 80% of all people with MS suffer from fatigue according to the National Multiple Sclerosis Society.


Primary fatigue

Primary fatigue is defined as fatigue caused by damage to the central nervous system including the brain, brainstem, and spinal cord. This damage can be caused by either inflammation or demyelination.

Many scientists and researchers believe that the fatigue is caused as a result of how the brain adjusts to the impact of MS.

Doctors have conducted MRI scans on people who have MS fatigue to try and learn more about this symptom. The results indicate that these individuals use a much larger area of the brain to carry out everyday activities than people without MS related fatigue. Scientist believe this could be an indication that the brain is trying to find new pathways for the messages to travel through when the normal pathways have become affected.

More research is needed to better understand the full range of primary mechanisms that are responsible for this symptom. To date, the 3 most discussed mechanisms are:

  • Cytokine influences
    • Interferon-γ
    • TNF-α
  • Endocrine influences
    • Hypothalamic-pituitary-adrenal (HPA) axis
    • Hormone dehydroepiandrosterone (DHEA)
  • Axonal loss and altered cerebral activation
    • See above with the MRI research which examined neural pathways

Secondary fatigue

Secondary fatigue is thought to be the result of issues that are related to multiple sclerosis, but are not directly caused by the disease. These include:

  • Muscle weakness
  • Acute and chronic pain
  • Depression
  • Tremors
  • Stiffness
  • Bladder incontinence
  • Lack of sleep or broken sleep
  • Muscle cramps and spams
  • Medications

Many people who suffer from MS also experience anxiety and depression, which can make a person feel more fatigued than normal.

Additionally, fatigue is a common side effect of many medications used to treat MS. Always be mindful of any medications that you take and be sure that you are taking them as prescribed. If you are taking non-prescribed medications, including over-the-counter drugs, be sure to share that information with your doctor as the medications can have different side effects when they are mixed.

NOTE: Always speak with your multiple sclerosis treatment team about physical symptoms and issues of mental health. Your clinicians can help connect you to resources and health providers in your area.


Tips for managing MS fatigue

As is common with many chronic conditions, maintaining a healthy lifestyle will help decrease the severity of many symptoms. Eating healthy foods – particularly lean meats, fruits, and vegetables – can influence your energy levels. It can be useful to track the foods that you eat to get a better understanding of the source of the calories that you eat.

In addition to eating habits, the following are good strategies to help battle fatigue:

  • Exercise
    • Walking, swimming, stretching, and other gentle exercises can be very useful
  • Take naps
    • Even if you don’t sleep, resting can help
  • Pace yourself
    • Building in time to rest during activities
  • Manage stress
    • Music therapy, art therapy, and other stress relieving exercises can provide relief from stress
  • Be patient with yourself

Looking for tips and tricks on how to battle fatigue? Check out support groups online and in-person.

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