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 reduce fatigue.

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 require a 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 differs from regular tiredness in that it’s usually not associated with physical or mental exertion or a 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.

  • 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, but not getting enough rest can make it worse.

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.

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 your healthcare team develop a management plan that addresses your specific fatigue symptoms.

All people will experience a degree of fatigue at some point. However, MS fatigue often differs in its intensity and impact.

For example, around 80% of people with MS experience a disabling level of 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, coordination difficulties, and other physical and cognitive challenges of MS.

Certain complications of MS may induce fatigue as well.

Complications and comorbidities (conditions that commonly co-occur) of MS that may worsen low energy and exhaustion may include:

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.

MS and activity levels

While conserving energy is important, not getting enough activity can be counterproductive. Exercising daily is essential for maintaining muscle strength and building endurance.

The idea behind conserving energy is not to spend too much time or effort on things that could be done or efficiently. This saves your energy so you can get more done and enjoy life before fatigue kicks in and limits you. Conserving energy is not the same as being lazy.

When you have MS, it’s also important to get some sunlight to boost your vitamin D, because vitamin D deficiency is associated with multiple sclerosis. Staying active and getting enough exercise maintains your cardiovascular health, muscle strength, muscle tone, and coordination – to avoid complications like muscle atrophy, muscle spasticity, heart disease, and obesity.

Other lifestyle changes

Other lifestyle changes and remedies can help you manage MS fatigue. These may include:

Managing stress with yoga, meditation, and tai chi may also help.

Managing fatigue is an integral part of comprehensive treatment for MS. Although there’s no cure for MS, treatments can help improve or slow the progression of symptoms, including low energy and exhaustion.

There are currently no FDA-approved medications for the specific treatment of MS fatigue. However, a healthcare professional may prescribe these medications to manage general fatigue symptoms.

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

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 can significantly impact 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.