What can a patient do to manage Multiple Sclerosis (MS) fatigue?

Managing Multiple Sclerosis Fatigue: Evidence-Based Patient Strategies

Patients with MS fatigue should engage in tailored physical activity interventions combined with structured psychoeducational programs as the primary management approach, as these non-pharmacological strategies demonstrate stronger and more significant effects on reducing fatigue severity compared to medications. 1

Core Management Strategy

Physical Activity Interventions (First-Line Approach)

Patients should participate in supervised, tailored physical activity programs that consider their current conditioning level, disease severity, and personal preferences. 2

• Aerobic/endurance exercise forms the foundation of effective fatigue management, with evidence showing improvements in aerobic capacity, fatigue reduction, and depressive symptoms 2, 3
• Physical activity should be gradually introduced and individualized based on current sedentary behaviors, disease activity, comorbidities, disability level, and patient goals 2
• Long-term lifestyle change is essential—unsupervised physical activity outside clinical settings provides sustained benefits beyond structured programs 2
• Specific beneficial activities include strengthening exercises, aerobic exercise, yoga, or tai chi, which demonstrate significant improvements in physical functioning, quality of life, pain, fatigue, and sleep quality 4

Psychoeducational Interventions (Essential Component)

Patients should access structured, time-limited psychoeducational interventions that go beyond simple information provision. 2

• These programs should explore thoughts, feelings (physical and emotional), and behaviors related to fatigue 2
• Interventions include cognitive behavioral therapy (CBT), group therapy, and psychoeducational self-management programs 2
• Periodic reassessment and repeated access to these interventions is necessary, as fatigue factors change over time and benefits from single interventions may not be maintained 2
• CBT specifically demonstrates moderate improvements in fatigue, distress, cognitive symptoms, and mental health functioning 4

Activity Management Strategies

Energy Conservation and Pacing

Patients must implement activity pacing and energy conservation strategies to avoid "boom and bust" patterns. 5

• Assessment should evaluate for "boom and bust" activity patterns where patients overexert during good days and crash afterward 5
• Structured pacing strategies help distribute energy expenditure throughout the day and week 5

Addressing Contributing Factors

Comprehensive Symptom Assessment

Patients should work with their healthcare team to identify and address modifiable contributors to fatigue. 5

• Evaluate and manage pain, sleep quality, mood disturbances, and physical activity levels 5
• Screen for respiratory insufficiency and nutritional deficits as contributing factors 6
• Address urinary dysfunction, muscular spasms, and sleep disorders that may worsen fatigue 7

Pharmacological Considerations

Medication Role (Secondary to Non-Pharmacological Approaches)

Amantadine is the only medication currently recommended for MS-related fatigue, though rehabilitation interventions show stronger effects. 1, 7, 8

• Amantadine and modafinil have positive results in controlled trials, but pharmacological agents often do not enable patients to cope with existing disabilities as effectively as rehabilitation 1, 8
• Avoid corticosteroids, antivirals, antibiotics, and stimulants as they show no benefit for fatigue symptoms 4
• Medication should be considered in conjunction with, not instead of, exercise and educational strategies 1

Critical Implementation Points

Proactive Clinical Engagement

Patients should not wait to raise fatigue concerns—they should expect their healthcare team to proactively assess fatigue at every visit. 5

• Assessment should include fatigue severity, impact on daily life, and coping strategies using validated screening tools 5
• Evaluation must address impact on daily activities, work, and social participation 5

Common Pitfalls to Avoid

The most dangerous error is accepting fatigue as an inevitable symptom without seeking active intervention. 5

• Do not assume fatigue correlates with visible muscle weakness or disease stage—fatigue occurs even when motor performance appears normal 5
• Reject generic advice—effective management requires structured, supervised interventions tailored to individual circumstances 5
• Avoid relying solely on pharmacological approaches—non-pharmacological strategies demonstrate superior effectiveness 1

Multidisciplinary Team Approach

Patients should engage with a multidisciplinary team including neurologists, MS nurses, occupational therapists, and physiotherapists for comprehensive fatigue management. 7

• Healthcare professionals should engage in shared decision-making about intervention options and facilitate access to physical activity and psychoeducational programs 2
• Mixed physical/psychological interventions with comprehensive approaches show excellent results for both fatigue levels and general MS management 7