Managing Fatigue in Multiple Sclerosis
Introduction Although fatigue is common among multiple sclerosis patients (85%), evaluation is difficult due to the subjectivity and variability of the complaint but it is important that fatigue is taken seriously and its management is considered carefully.
Unfortunately fatigue interferes with work, family, and social life and is increasingly recognised as a significant symptom for people with MS.
The effective management of fatigue has an important impact on the patient's functioning, abilities, and quality of life.
There has long been a belief that depression contributes to fatigue in multiple sclerosis (MS) although supporting data are minimal at best.
A number of methods of measuring fatigue in multiple sclerosis have been developed including the Fatigue Descriptive Scale (FDS) developed by Iriarte J, Katsamakis G, de Castro P.
and the Fatigue Severity Scale (FSS) which was designed to differentiate fatigue from clinical depression, since both share some of the same symptoms.
A Common Symptom Fatigue is, perhaps, the most common symptom of multiple sclerosis, with the majority of people with MS experiencing it at some point in the course of the disease.
Fatigue Management can be largely achieved with Occupational therapy, to simplify every-day tasks, Physical therapy, to find more energy-efficient ways of daily tasks, Relaxation training, Heat management and Medication (e.
g.
Amantadine and Modafinil).
Treatment Treatments can be classified in two main subtypes: pharmacological and non pharmacological.
Drug treatments for fatigue in multiple sclerosis include Amantadine, Modafinil, Pemoline, and Methylphenidate.
In addition to treating fatigue in multiple sclerosis, Modafinil is also used to treat Alzheimer's disease, depression, attention-deficit disorder, myotonicdystrophy, schizophrenia and cocaine addiction.
A trial of aspirin therapy for fatigue may be a reasonable first step in medication management.
Aspirin seems to have shown similar results to Symmetrel (Amantadine) although the doses needed could cause gastrointestinal bleeding in some people In a recent survey of neurologists it was found that most favored research directed toward understanding the cause of fatigue in multiple sclerosis, while one-third said research should be focused on the development of new medications.
However, in line with the theory that MS could be significantly affected, if not caused, by environmental factors such as infections there has been some success in reducing fatigue in multiple sclerosis with treatments designed specifically to reduce Candida activity.
This lends further support for the suggested relationship between MS related fatigue and Candida activity.
Although a number of strategies have been devised for reducing fatigue, treatment recommendations are based on a limited amount of scientific evidence.
Recent advances in the understanding of the pathophysiology of multiple sclerosis (MS) are providing fertile ground for the development of unique treatment approaches.
Sleep Sleep disturbances are common in people with MS, due to spasms, depression or anxiety, pain, the frequent need to urinate at night (nocturia) or because of side effects of medications (corticosteroids like Solu-Medrol are notorious for causing sleep disturbances).
While fatigue is almost exclusively a subjective experience, depending on the patient's ability to understand and report this symptom, there are effective methods for identifying the existence of fatigue, determining its severity, and distinguishing it from related or contributing disorders such as depression, pain, and sleep disorders.
Much of the physical fatigue can be attributed to disturbed sleep patterns caused by urinary urgency or nocturnal spasms (myoclonus).
There may also have periodic leg movements, which is when legs kick involuntarily during sleep.
Another condition affecting sleep is sleep apnea, which is also common among the general population.
Exercise Exercise can cause problems for people with multiple sclerosis because the resulting overheating can make neurological symptoms worse.
Mental fatigue can vary between mild and severely disabling and is usually exacerbated by exercise, increased bodily or ambient temperature (Uhthoff's symptom).
Mental fatigue is often associated with physical fatigue and all you want to do after physical exercise is to collapse on a bed and sleep.
It is important to keep up with what exercise one is capable of to prevent the muscles from atrophying and to keep the nerve pathways as operational as possible.
Whatever the workout method, exercise seems to help MS patients reduce fatigue symptoms, Bourdette said.
"This is true whether the regular exercise is yoga, swimming, using a stationary bicycle or any other physical activity," Conclusion Daily lives are increasingly more demanding and with the complexity of fatigue in MS, you must expect that a multi-strategy approach will be needed to make an impact on managing your fatigue.
Unfortunately fatigue interferes with work, family, and social life and is increasingly recognised as a significant symptom for people with MS.
The effective management of fatigue has an important impact on the patient's functioning, abilities, and quality of life.
There has long been a belief that depression contributes to fatigue in multiple sclerosis (MS) although supporting data are minimal at best.
A number of methods of measuring fatigue in multiple sclerosis have been developed including the Fatigue Descriptive Scale (FDS) developed by Iriarte J, Katsamakis G, de Castro P.
and the Fatigue Severity Scale (FSS) which was designed to differentiate fatigue from clinical depression, since both share some of the same symptoms.
A Common Symptom Fatigue is, perhaps, the most common symptom of multiple sclerosis, with the majority of people with MS experiencing it at some point in the course of the disease.
Fatigue Management can be largely achieved with Occupational therapy, to simplify every-day tasks, Physical therapy, to find more energy-efficient ways of daily tasks, Relaxation training, Heat management and Medication (e.
g.
Amantadine and Modafinil).
Treatment Treatments can be classified in two main subtypes: pharmacological and non pharmacological.
Drug treatments for fatigue in multiple sclerosis include Amantadine, Modafinil, Pemoline, and Methylphenidate.
In addition to treating fatigue in multiple sclerosis, Modafinil is also used to treat Alzheimer's disease, depression, attention-deficit disorder, myotonicdystrophy, schizophrenia and cocaine addiction.
A trial of aspirin therapy for fatigue may be a reasonable first step in medication management.
Aspirin seems to have shown similar results to Symmetrel (Amantadine) although the doses needed could cause gastrointestinal bleeding in some people In a recent survey of neurologists it was found that most favored research directed toward understanding the cause of fatigue in multiple sclerosis, while one-third said research should be focused on the development of new medications.
However, in line with the theory that MS could be significantly affected, if not caused, by environmental factors such as infections there has been some success in reducing fatigue in multiple sclerosis with treatments designed specifically to reduce Candida activity.
This lends further support for the suggested relationship between MS related fatigue and Candida activity.
Although a number of strategies have been devised for reducing fatigue, treatment recommendations are based on a limited amount of scientific evidence.
Recent advances in the understanding of the pathophysiology of multiple sclerosis (MS) are providing fertile ground for the development of unique treatment approaches.
Sleep Sleep disturbances are common in people with MS, due to spasms, depression or anxiety, pain, the frequent need to urinate at night (nocturia) or because of side effects of medications (corticosteroids like Solu-Medrol are notorious for causing sleep disturbances).
While fatigue is almost exclusively a subjective experience, depending on the patient's ability to understand and report this symptom, there are effective methods for identifying the existence of fatigue, determining its severity, and distinguishing it from related or contributing disorders such as depression, pain, and sleep disorders.
Much of the physical fatigue can be attributed to disturbed sleep patterns caused by urinary urgency or nocturnal spasms (myoclonus).
There may also have periodic leg movements, which is when legs kick involuntarily during sleep.
Another condition affecting sleep is sleep apnea, which is also common among the general population.
Exercise Exercise can cause problems for people with multiple sclerosis because the resulting overheating can make neurological symptoms worse.
Mental fatigue can vary between mild and severely disabling and is usually exacerbated by exercise, increased bodily or ambient temperature (Uhthoff's symptom).
Mental fatigue is often associated with physical fatigue and all you want to do after physical exercise is to collapse on a bed and sleep.
It is important to keep up with what exercise one is capable of to prevent the muscles from atrophying and to keep the nerve pathways as operational as possible.
Whatever the workout method, exercise seems to help MS patients reduce fatigue symptoms, Bourdette said.
"This is true whether the regular exercise is yoga, swimming, using a stationary bicycle or any other physical activity," Conclusion Daily lives are increasingly more demanding and with the complexity of fatigue in MS, you must expect that a multi-strategy approach will be needed to make an impact on managing your fatigue.
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