Best Treatment For Ms Fatigue

What Are Some Medical Treatments For Ms

In general, if possible, it is good to avoid using medications. People with MS often take several medications. Limiting the number of medicines is good medical practice. It is also important in reducing costs. However, if fatigue continues to interfere with activities, medications may be useful. These medications may include:

Last reviewed by a Cleveland Clinic medical professional on 01/28/2019.

References

Take Rest When You Need It

For some people, rest helps relieve fatigue and is an important part of fatigue management. Resting can prevent you getting to a point of complete exhaustion and coming to a sudden halt, mid task.

A few small breaks are best for some people or you might feel better after just one longer rest at a particular time.

For example:

• try taking a few short rests or power naps,
• through the day try just one longer rest,
• at the same time each day take a break between coming home from work and getting ready for an evening out

When you rest, try to make your rest as complete as possible. Doing smaller jobs around the house, talking to the family or watching TV might be more relaxing than work or chores, but it is not really resting. It can be tricky, but the aim should be to switch off both the mind and the body.

You might want to have a short sleep, or use relaxing music to help you clear your mind. Some people find yoga, mindfulness or meditation useful.

If worries disturb time set aside for rest, try writing down these concerns and ‘shelving’ them while you are resting. You will have more energy to tackle them once your energy levels are up again.

If resting helps you manage your fatigue, it is important that other people realise how valuable this quiet, undisturbed time is.

Above all don’t feel guilty about taking rest when you need it. If this is something you find challenging our online fatigue management course can help you think it through.

A Little More Strength To Carry The Weight

In my experience, it’s not like you take a pill and, just like that, no more fatigue until the pill wears off. When I take my medication, the fatigue is still there, but it becomes easier to work through it kind of like how cold medication doesn’t eliminate a cold, but it may help reduce the symptoms of one. If you think of fatigue like the weight of a huge boulder on your back that you have to walk around with, I would say that these medications don’t really remove the weight of the boulder but instead give you a little more strength to carry it. The heaviness in my body caused by my fatigue is always there, but these medications make it a little less difficult to not be crushed by it. At least that how it feels to me.

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Take Breaks And Pace Yourself

Pacing yourself and taking breaks during the day can help you stay healthy, says Wentink.

When Im drained and continue to push, I think Im putting myself at risk for getting sick, he says. When I feel fatigued, I take it as a sign that I need to step back and take a break.”

Symptoms tend to get worse when severe fatigue sets in, says Wentink. I try to slow down before that happens because I dont want to bring on a relapse, he adds.

Evidence For Pharmacological Interventions For Fatigue In Persons With Ms

Currently, different pharmacological agents are used for treatment for fatigue in pwMS, which include amantadine, modafinil, and pemoline . Modafinil, a wake promoting agent that selectively works in the hypothalamic pathways used in narcolepsy, has been reported to improve fatigue in progressive MS . The efficacy of pemoline, a CNS stimulant, is still unclear . Amino pyridines and amantadine have been trialed however, systematic reviews failed to find evidence for efficacy or safety for their use . There is empirical support for use of antidepressants in MS-related fatigue, as depression is considered to be one of the major contributing factors .

One comprehensive systematic review exploring efficacy of different pharmacological treatments on non-specific fatigue in palliative care included 10 studies investigating amantadine , pemoline, and modafinil in pwMS . The authors reported mixed results with weak and inconclusive data. Amantadine was found to demonstrate some improvement in fatigue in pwMS . Both pemoline and modafinil failed to demonstrate a significant effect for management of fatigue in pwMS .

Commonly used pharmacological agents for fatigue and MS are summarized in Table 3, along with indications, doses, and side effects.

Table 3. Commonly used pharmacologic treatments for MS-related fatigue.

Summary

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Finding Help And Taking Help Thats Offered

People might say to you If theres anything you need or If theres anything I can do, but it is not always easy to ask for help, even when it is offered.

It can be useful to prepare a list of tasks that youd like help with. That way, if someone does offer to help, you can easily tell them how they could help.

If you find it hard to take, or ask for help, our fatigue management course could help you!

How This Study Was Carried Out

Two MS clinics in the United States recruited 141 participants with MS who were affected by fatigue and had low to moderate disability.

Participants were assigned to take the medications in one of four sequences. They started taking one medicine and took it for six weeks, followed by a two-week washout period and repeated this process for all three medicines and the placebo. Neither participants nor the researchers knew which medication they were currently taking.

Methylphenidate, also known as Ritalin, is a central nervous system stimulant used to treat narcolepsy and attention deficit hyperactivity disorder. In the States it is sometimes used to treat MS fatigue, but is rarely used for this purpose in the UK.

Fatigue was measured at the beginning of the study using the Modified Fatigue Impact Scale and again during week 5 of each treatment period. MFIS is a questionnaire which you complete yourself. It assesses the impact of fatigue on different aspects of daily life: physical activity, thinking processes and taking part in social activities. People were included in the study if their MFIS was 33 or greater. Read more about the MFIS and test yourself.

Participants also completed the Epworth Sleepiness Scale which measures daytime sleepiness and a questionnaire which assessed the impact of fatigue on quality of life.

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Other Causes Of Fatigue

Some fatigue experienced by people with MS is not actually caused by the MS. For example, a person might feel fatigued due to poor sleep, infection, medications, or depression.

Medications taken to solve other problems can contribute to fatigue. If you look at your pill bottles, some say, May cause drowsiness or Do not operate heavy machinery while taking this medication. These warnings indicate that the medicine is sedating, i.e., it can make you tired. Medications that are used to treat bladder dysfunction, spacticity, and pain can cause fatigue in MS patients. If this is the case and you are experiencing fatigue, a good place to begin is to review all of your medications with your physician.

Medical Marijuana And Multiple Sclerosis

It is possible to manage some of the specific symptoms of multiple sclerosis with the aid of medical marijuana. Proponents of cannabis suggest that the plant helps with severe pain and fatigue. These are two of the most pertinent MS symptoms. There is a suggestion that marijuana can also assist with mood changes and stress.

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Get Help For Depression

If you are feeling down and hopeless, or if things that used to be enjoyable dont interest you anymore, you may be depressed. Depression is one of the most common symptoms of MS, and left untreated, it can make your fatigue worse.

Depression is treatable, so if you think you might be depressed, tell your healthcare provider right away.

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Engage In Regular Physical Activity

I encourage exercise for my patients, says Conway. In my experience, it can make fatigue worse at first, but if a person can get over the initial hump, it can actually improve fatigue, he says.

If youre not sure how to get started with exercise or need some help identifying exercises that will improve your fitness without wearing you out, trying working with a physical therapist or a personal trainer who is knowledgeable about MS.

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What Else Can I Do To Manage These Symptoms

It can be useful to learn to recognise the early signs of fatigue and how it affects you. Likewise, talking with family, friends and/or colleagues may help them understand any limitations. Identifying any contributing factors to your MS fatigue, can help you develop a tailored management plan with your healthcare professional. Recent research is strongly supporting the role of exercise in managing fatigue. Even though it may seem counterproductive to exercise when feeling so tired, it can be a very effective management tool for many, and of course has other benefits towards health and wellbeing.

Fatigue management strategies include:

• Maintain a well-balanced diet to increase energy levels.
• Stay hydrated.
• Stay active low or no activity can increase fatigue, and regularly used muscles help to provide energy to accomplish tasks.
• Monitor sleep patterns and address any issues.
• Manage other contributing MS mental health symptoms, such as depression, anxiety or stress.
• Rest and take time to relax to decrease muscle tension and ease stress.
• Vary heavy with lighter tasks for example, if you have more fatigue in the afternoon, do harder jobs in the morning. Or prioritise those jobs which need to be done before others.
• Manage any heat sensitivity. Even the smallest increase in temperature can increase a persons fatigue. Like MS fatigue and the need to rest and recover, your body needs to cool down if affected by heat and humidity. Read more about heat sensitivity and MS here.

The Top Herbs And Supplements For Ms

The following list doesnt cover every available herbal or supplementary option for treating the symptoms of MS. Instead, the list offers a brief summary of the important information about each of the most common herbs and supplements that people with MS use.

• stress relief
• anxiety

Although some research into how ashwagandha can protect the brain has been promising, its not been studied well enough to know whether it can effectively treat multiple sclerosis or its symptoms.

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Does This Surprise You

People with MS have been using these medications for years in an effort to tame the fatigue monster, so its no wonder I was surprised by these results. Maybe I shouldnt have been. The folks at the National MS Society remind us that no medications are approved specifically to treat MS fatigue. Everything that people with MS use is prescribed off-label.

Clinical trials of meds for MS fatigue have produced mixed results. As the Cleveland Clinics website reports, two studies have looked at modafinils effects on MS fatigue. One showed a significant effect on fatigue, but the other did not. Interestingly, the clinic also noted that a recent study found that taking two regular aspirins twice a day significantly reduced MS fatigue.

Treatment For Ms Relapses

Contact your specialist MS nurse or GP if you think youre having a relapse.

A flare-up of symptoms can sometimes be caused by something other than a relapse, such as an infection, so your nurse or GP needs to check for other possible causes.

Treatment for a relapse usually involves either:

• a 5-day course of steroid tablets taken at home
• injections of steroid medicine given in hospital for 3 to 5 days

Steroids can help speed up your recovery from a relapse, but they dont prevent further relapses or stop MS getting worse over time.

Theyre only given for a short period of time to avoid possible steroid side effects, such as osteoporosis , weight gain and diabetes, although some people will still experience problems.

Not using steroids more than 3 times a year will also help to reduce the risk of side effects.

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What Is The Best Treatment For Fatigue In Multiple Sclerosis

Although fatigue seems to be a vague and subjective symptom, it is one of the leading reasons why victims of MS are unable to work.

No drugs are very useful for this symptom, but some are still prescribed.

Amantadine may reduce fatigue, usually in doses of 100 mg twice daily.

Modafinil and selective serotonin reuptake inhibitors such as fluoxetine also are prescribed.

Simple commonsense measures may be more useful, such as resting during the day and reorganizing the home and workplace for better efficiency.

What Causes Fatigue In Patients With Multiple Sclerosis

The exact cause of MS-related fatigue is still unknown. There are several theories on the subject:

• One theory is that fatigue is related to the general activation of the immune system. Chemical messengers are called cytokines these levels are higher in patients with MS and may be higher still in patients with fatigue. One way of describing this is that you may feel like you have a virus all of the time.
• Another theory is that people with MS may have to use more parts of their brain to do the same task as someone without MS in essence, they are working harder.
• Another theory is that fatigue is related to reduced electrical transmission of signals in the brain.

Whatever the theory, we know that fatigue from MS is a very real part of the disease.

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Evidence Maps On Treatments For Fatigue In Ms

A broad range of fatigue interventions for multiple sclerosis exists, including drugs, exercise, cognitive behavioral therapy, self-management strategies, and non-invasive brain stimulation. However, important questions remain regarding efficacy. The development of these evidence maps involved a systematic identification of relevant research studies of fatigue interventions in MS, along with data extraction, meta-analyses, and strength of evidence ratings.

These maps were created, in part, to help patients and those who care for them make informed decisions for a condition with multiple interventions available that typically may be selected based on individual preference or individual characteristics. The maps were primarily developed as pilots, to explore various methodologic issues encountered in this emerging form of evidence synthesis.

For the best map interaction experience, we recommend viewing these evidence maps on desktop-sized devices in a Chrome, Safari, or Firefox browser.

Bone Up On Calcium And Vitamin D

According to the NMSS, research is increasingly showing that low vitamin D levels in the blood may be a risk factor for developing MS, though more research is needed to find out whether vitamin D has any impact on disease activity in people with the condition.

But experts do know that getting enough vitamin D and calcium is key for bone health among people who already have MS.

Its a good idea to incorporate foods high in vitamin D and calcium into your diet, especially if you have been on steroids for a long time, Eng says, because one side effect of steroids is poor bone health. Low levels of weight-bearing activity, such as walking, can also lead to weak bones and a higher fracture risk.

Steroids are often prescribed only as a short-term, first-line treatment for MS exacerbations usually for three to five days via IV, and sometimes followed by a tapering oral dose for one to three weeks.

But some comorbid conditions that are common in people with MS, including inflammatory bowel diseases like Crohns disease or ulcerative colitis, require long-term steroid use. And per the NMSS, steroid treatment can lead to bone loss if used for prolonged periods of time.

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Good food sources of vitamin D include fortified milk and orange juice, cod liver oil, and fatty fish. Small amounts of vitamin D are naturally present in egg yolks and cheese.

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What If Oral Medications Wont Work For Me

Since Tecfidera did not work for me, my neurologist sent me to an MS specialist who then put me on Ocrevus, an infused medication. While I did not have any new lesions while on this medication, I found myself fatigued, in a lot of pain, and bedridden for the six months between infusions. I can only share my experience.

As you know, MS is different for every person. The same holds true for the medications. Many people swear by Ocrevus and have shown major improvement while on it. I felt better once it left my system, so I swore off medications for a little over a year.

My most recent trial was Tysabri, an infused cousin to Ocrevus. Ive been taking it for almost one year. It took about six infusions for my body to adjust, but after that time, it was okay. Other infusion medications for MS include Lemtrada and Novantrone.

Some choose the oral route because its easier and much less time consuming than sitting at a hospital for hours hooked up to an IV for an infusion. I have no experience with the next type of medication, self-injectables, but I have heard and read mixed reviews.

If you choose a self-injectable treatment, there are some tips Ive found to help make you more comfortable :

• Rotate your injection site to protect your skin
• Take treatment as prescribed

Always remember to talk to your doctor or healthcare professional about how to exercises or other resources to help minimize your pain and help you feel more comfortable.

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