The Challenge of Treating Fatigue in Multiple Sclerosis: Anthony Feinstein, MPhil, PhD, FRCP

In patients with multiple sclerosis (MS), fatigue is the most commonly reported symptom, and is known as one of the most debilitating symptoms of the disease. Despite the high prevalence and significant impact of fatigue in MS, the symptom remains understudied because of its complexity and subjective nature.¹ Over the years, research from specialists in neurology has opened the door to understanding the potential causes, impact, and treatment of MS-related fatigue. As an approach to treating fatigue, both pharmacological and nonpharmacological interventions are used in combination, encompassing a multi-disciplinary approach, in the current clinical practice.

Research shows that nonpharmacological interventions show a stronger and more significant favorable impact on reducing the impact or severity of fatigue compared with commonly prescribed pharmacological therapies. According to a prior review published in Frontiers in Neurology, findings suggest that nonpharmacological approaches used in isolation or in combination with pharmacological agents should be the mainstay of management of fatigue in patients with MS.²

Anthony Feinstein, MPhil, PhD, FRCP, a professor of psychiatry at the University of Toronto, presented on the management of fatigue in MS in a session at the 2024 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 29 to June 1, in Nashville, Tennessee. At the meeting, Feinstein sat down in an interview with NeurologyLive^® to discuss the common secondary causes of fatigue that should be ruled out before treating primary fatigue in patients with MS. He also talked about how cognitive behavioral therapy compares with pharmacologic medications in managing fatigue in MS based on recently published research. Furthermore, he spoke about the potential benefits and limitations of using mindfulness therapy for fatigue in MS.