Fatigue: Pharmacological and non-pharmacological management in patients with multiple sclerosis

Abstract

Multiple sclerosis (MS) is a neurological disease that causes inflammation and demyelination of the central nervous system. It progresses with episodic attacks and is particularly disabling in young adults. Among the many symptoms experienced by MS patients, fatigue is one of the most commonly reported. Approximately 75 – 90% of patients experience fatigue, with the vast majority reporting it as one of their top three symptoms. Over half of MS patients find fatigue to be a debilitating symptom that interferes with their work, family, and social life, significantly affecting their overall quality of life. Despite its prevalence, fatigue is often overlooked due to its subjective nature. Although the pathophysiology of fatigue is not fully understood, it has been associated with various variables such as stress, vigorous exercise, anxiety, depression, insomnia, pain, spasticity, medication side effects, anemia, and temperature elevation. Effective management of multifactorial fatigue requires a multidisciplinary approach, incorporating both pharmacological and non-pharmacological modalities. An analysis of studies conducted over the last decade indicates that the efficacy of pharmacological methods is controversial, with a high side effect profile. Among non-pharmacological methods, exercise has proven to be one of the most effective interventions. In addition, dietary modifications and vitamin supplementation have demonstrated effectiveness. Cognitive behavioral therapy, acupressure, acupuncture, the application of cooling garments, transcranial stimulation, web-based education and counseling, and guided imagery have also reported positive results. However, further studies with larger sample sizes are necessary to objectively evaluate their effectiveness. In conclusion, fatigue is a prevalent symptom among MS patients. While the management of fatigue through pharmacological methods remains controversial, non-pharmacological methods have demonstrated effectiveness, are low-cost, and have no side effects.