Fatigue Management

Earlier this year, MS Ireland hosted a webinar on fatigue management with Dr Michelle Murphy. Below is a summary of the information provided in the webinar.

The symptoms of Multiple Sclerosis can vary greatly from one person living with the condition to another. Fatigue is a very common symptom of MS, impacting between 75-90% of people living with MS, on some level. Fatigue can create feelings of exhaustion, tiredness, weariness or lack of energy. It is different to the fatigue experienced by those who do not live with MS. MS related fatigue can be very difficult to diagnose, understand and communicate. But what exactly causes fatigue? What effective techniques or strategies can be used to manage fatigue?

What causes fatigue?


There are two different types of fatigue, primary fatigue and secondary fatigue.


Primary fatigue is the direct result of damage to the central nervous system (brain and spinal cord. It can be caused by hormones, demyelination, inflammation and even how we use our brain. MRI’s have indicated that people living with MS sometimes use more of their brain in order to carry out a task than people that do not live with the condition. Demyelination in MS results in damage to the nerves in the brain that conduct signals, enabling us to use our bodies. This damage can result in our brains having find a new route to send a signal. More of the brain is used, resulting in fatigue.


Secondary fatigue is caused by factors that may be related to MS but are not directly caused by MS. It can relate to MS symptoms such as muscle weakness, tremor or pain. Infections, a rise in temperature and medication can also lead to secondary fatigue. Factors associated with living with MS such as lack of sleep, lower levels of mobility and cognitive or emotional impacts can also lead to secondary fatigue.


What does fatigue look like?


There are various forms of fatigue including:


Physical fatigue - The body is working harder to function which can result in physical fatigue. This can result in muscle weakness.


Psychosocial fatigue - You may experience difficulty in getting motivated, you may feel low or worn out. Being in a group or conversing with people may feel overwhelming. Psychosocial fatigue is related to low mood, anxiety and struggling with social environments.


Cognitive/Mental fatigueDifficulty with concentrating, focusing, processing and recalling information.


How can fatigue be managed?


Everyone’s experience with fatigue is unique. What helps one person to manage fatigue may be different to what helps another. It is important to find the strategies that work for you. Here is a selection of strategies that can be used to help manage fatigue.


  • First, you need to identify what your triggers are as they will be important in determining appropriate strategies to manage fatigue. A way to do this is to develop a fatigue diary in which you log your daily activities, your rest and your fatigue levels. This may help you to identify behaviours that might be contributing to fatigue. It is important to complete this on good and bad days to help identify patterns.
  • Next, you develop strategies based on the triggers and patterns of behaviour you have identified. For example, if you identify that your cognitive function is better in the evening than in the morning, you could move some of the more cognitively demanding tasks to the evening.
  • A to-do-list and prioritising activates can save energy and ensure important tasks get done at a time that is suitable for you.
  • You may also find it useful to break activates down into a series of smaller tasks.
  • Be realistic with how much you can get done in a day. You need to consider that fatigue may feature.
  • Ask for help with certain tasks. Be aware of your limitations and what might be very demanding of your energy and ask for help. For example, if you are planning to do the grocery shopping, it may be helpful to have someone pack the groceries or help put them away when you get home. These little energy savings can make a difference! Remember that asking for help is a sign of strength, organisation. It shows that you are motivated to stay well.
  • Minimise distractions. For example, if you are reading the newspaper and the radio is on in the background, your attention may be switching from one to the other. Switching off the radio may help you to focus on reading the newspaper and reduce cognitive demand.
  • Focus one one task at a time, if and where you can.
  • Repetition can be helpful in creating a routine so your brain doesn’t need to think about certain things all of the time.
  • Creating associations between things you might need to remember can help. An example is having basket by the door that you put your keys in so your brain knows the keys go in the basket every time. Having certain things in certain places can help your brain to build ‘muscle memory’ so it doesn’t have to overthink.
  • Visual or verbal cues Finding different ways to perform tasks. Here may often be tasks you have to complete regardless of whether or not you are experiencing fatigue. So finding ways to complete those tasks in a way that is less demanding of your energy could help. Perhaps that looks like sitting down to fold laundry instead of standing to do it.
  • Visual or verbal cues or reminders can be of great use.
  • Prioritising the information, you want to focus on may be beneficial. When receiving information, focus on the parts that matter most.
  • It may be useful to adopt memory/attention aids such as checklists, a notebook, wall planner/calendar, alarms/timers or a Dictaphone.


Rest is essential in managing fatigue. Pace yourself, take regular rests and allow your brain to decompress.


Developing a good sleep routine is also a very important element in fatigue management.


What can I do to help with cognitive fatigue?


  • Some activities can help with cognitive fatigue. These include jigsaws, cards, listening to music, meditation, word searches or even engaging with memory matching or attention test apps.
  • Assess your environment. You want to create an environment that is easy to move around. Storing heavy items at a low level. Keep items you regularly use within reach. If there are items you use together, you could store them together. Try keep clutter to a minimum and keep items in the same place, if you can.
  • Medication can sometimes impact fatigue. Someone could feel immediately better or worse after taking their medicine. Plan activities around those times. If your fatigue is persistent on your medication, it may be worth flagging this with your healthcare provider in case any tweaks or changes are required.
  • Try to maintain a healthy lifestyle with a well-balanced diet and exercise at a level that is suitable for you. It is also important to try avoid or minimise stress. Stress can cause fatigue as our bodies can become tense or tight and we are in a state of ‘fight or flight’.

If you need support with fatigue management, please speak to your healthcare provider who may be able to provide individualised support, advice or information for you.

This webinar this information is extracted from is available on our website in our online video catalogue, alongside a number of other interesting talks by expert speakers.