Treating Fatigue in Multiple Sclerosis

Fatigue.  It is one of the most commonly reported symptoms by people living with multiple sclerosis (MS).  Not only do many people experience it, but they also indicate that it is the symptom that has the biggest impact on their quality of life.

Considering this, it makes sense that treating fatigue would be an incredibly helpful part of an individual’s MS management plan.  There are many strategies that are being investigated to improve fatigue in people living with MS, including lifestyle modifications, new pharmaceutical options and even a daily cup of cocoa!

In this article, we are going to focus on three of the more common therapeutic agents that are prescribed for fatigue:  amantadine, modafinil and methylphenidate.

While all three have shown the potential to improve fatigue in people living with multiple sclerosis, a trial published in Lancet Neurology earlier this year (abstract available here), has raised some important questions.

In this study, it was shown that although these treatments did all reduce fatigue levels, none performed better than placebo.  As a reminder, a placebo is a substance that has no therapeutic effect (often a sugar pill) and is used as a control in trials for new therapies.  From this, the researchers concluded that the benefits experienced by people taking these medications was most likely due to a placebo effect.  You can read more about the placebo effect in an article by Harvard Medical School, available here.

Knowing this, we are left with the following questions (which were also discussed in a recent review by the researchers that conducted the trial – abstract here.

1. Should these treatments continue to be prescribed to people living with multiple sclerosis?

We know that people taking them commonly report that it helps lower their fatigue, but this recent trial suggests that it isn’t the drugs themselves that are having that effect.  Considering the treatments also come with a number of side-effects, is it ethical to still use them?

2. If people are already taking them and feeling better, should they be stopped because of this new information?

Does the answer to this depend on whether they have any negative side-effects from the therapies or not?  Who then decides if the benefits outweigh the risks?  Can this discussion be had without losing (at least some of) the placebo effect?

I would love to hear the thoughts of the MS community on these questions.  As always, you can have a discussion with us on any of our social media platforms, or you can send me an e-mail at brett@mstranslate.com.au.

Until next time.

Brett.

Join the conversation on all things related to multiple sclerosis research by connecting with us on social media.  You can find us on Facebook, Twitter, YouTube, Instagram and LinkedIn.

Read other article we have published on the topic of fatigue by clicking here.