From the Guidelines
Fatigue is a prevalent and debilitating symptom in Multiple Sclerosis (MS) patients, and managing it requires a comprehensive approach that incorporates regular assessment, tailored physical activity interventions, and structured psychoeducational interventions, as recommended by the 2023 EULAR guidelines 1. To address fatigue in MS patients, it is essential to conduct regular assessments of fatigue severity, impact, and coping strategies, and to incorporate these assessments into clinical consultations.
- The 2023 EULAR guidelines recommend using a single-item instrument as a screening tool, such as the BRAF-NRS or RAID-F, which can be supplemented by additional multidimensional assessments if significant levels of fatigue are identified 1.
- Tailored physical activity interventions, such as supervised physical activity programs, can help reduce fatigue in MS patients, and long-term physical activity as a lifestyle change should be encouraged 1.
- Structured and tailored psychoeducational interventions can also help reduce fatigue in MS patients, and these interventions should explore the thoughts, feelings, and behaviors of the patient in relation to their fatigue 1. The presence or worsening of fatigue should trigger an evaluation of inflammatory disease activity status and consideration of immunomodulatory treatment initiation or change, if clinically indicated, as pharmacological interventions that reduce disease activity can also reduce fatigue in MS patients 1. While some studies suggest that vitamin D supplementation may have a beneficial effect on MS activity and relapse rate, the evidence is inconclusive, and more research is needed to fully understand the relationship between vitamin D and MS fatigue 1. Overall, a comprehensive approach that incorporates regular assessment, tailored physical activity interventions, and structured psychoeducational interventions is recommended for managing fatigue in MS patients, with the goal of improving morbidity, mortality, and quality of life outcomes.
From the Research
Relationship Between Fatigue and Multiple Sclerosis (MS)
- Fatigue is one of the most common and disabling chronic symptoms in multiple sclerosis (MS) 2, 3, 4, 5, 6
- The relationship between fatigue and MS is complex, and fatigue can be as disabling as objective neurological deficits 3
- Fatigue in MS can be caused by various factors, including urinary dysfunction, pain, muscular spasms, and sleep disorders 3
Treatment Options for MS-Related Fatigue
- Pharmacological treatments for MS-related fatigue include amantadine, modafinil, and acetyl-L-carnitine (ALCAR) 3, 5
- Non-pharmacological approaches for MS-related fatigue include cognitive behavioral therapy (CBT), physical therapy, and mixed physical/psychological interventions 3, 4, 6
- Combination therapy of CBT and modafinil may be effective in reducing fatigue in MS patients, but more research is needed to determine its effectiveness 2, 4
Effectiveness of Cognitive Behavioral Therapy (CBT) for MS-Related Fatigue
- CBT has been shown to have positive effects on MS-related fatigue, with varying onset and duration of effects across studies 6
- CBT may be a promising treatment option for MS-related fatigue, but more research is needed to fully understand its effects and to develop effective treatment protocols 6
Comparison of Treatment Options for MS-Related Fatigue
- A randomized, statistician-blinded, parallel-arm trial compared the effectiveness of CBT, modafinil, and combination therapy for treating fatigue in MS, and found that all three treatments were associated with similar reductions in fatigue 4
- Another study found that amantadine was effective in reducing fatigue in MS patients, while modafinil and ALCAR showed only a trend of improvement 5