Medication and cognitive behavioral therapy (CBT) have both demonstrated efficacy in alleviating fatigue associated with multiple sclerosis (MS), according to a new study published in The Lancet Neurology. The research indicates that either treatment, whether administered independently or in combination, can lead to significant improvements in fatigue levels among MS patients.
MS patients who were prescribed modafinil (Provigil), a medication known for promoting wakefulness and commonly used to treat sleepiness, experienced a notable reduction in fatigue. Similarly, patients undergoing CBT, which involves learning to identify and manage factors that exacerbate or alleviate fatigue symptoms, also reported less fatigue. Combining both treatments did not yield significantly different results compared to either treatment alone.
Key Findings on Treatment Efficacy
The study, led by Dr. Tiffany Braley, director of the University of Michigan Health’s Multiple Sclerosis/Neuroimmunology Division, highlights the potential of both CBT and modafinil as effective treatments for MS-related fatigue. "This research offers new evidence to show that both CBT and modafinil are comparably effective for MS fatigue, which could shape treatment approaches to one of the most challenging symptoms experienced by people with multiple sclerosis," said Dr. Braley.
The research involved nearly 340 patients who were randomly assigned to receive either CBT, modafinil, or both. The results indicated that over 60% of participants in each group reported clinically meaningful improvement in their fatigue.
The Role of Sleep Hygiene
Interestingly, the study revealed that a person's sleep habits influenced the effectiveness of each treatment. Participants with poor sleep hygiene tended to experience better fatigue outcomes with CBT, while those with good sleep hygiene showed greater improvement with modafinil.
According to Dr. Braley, "Using wake-promoting medications such as modafinil could worsen sleep quality in patients whose sleep problems are behavioral in nature. As sleep disturbances also contribute to fatigue in people with MS, it is important to avoid selecting fatigue treatments that could make sleep worse. Behavioral treatments such as CBT that include sleep education may be preferable for people with MS who have poor sleep habits."
Implications for Treatment Strategies
The study underscores the importance of considering individual sleep habits when determining the most appropriate treatment for MS-related fatigue. Senior researcher Anna Kratz, a professor of physical medicine and rehabilitation at the University of Michigan Medical School, emphasized the potential benefits of CBT, particularly when delivered via telehealth to improve access for patients with limited access to behavioral health care. "Our study shows that CBT is a feasible treatment that teaches fatigue management skills that can be employed indefinitely, with enduring benefits that last well beyond the treatment period," Kratz noted.
Background on MS and Fatigue
Fatigue is a common and debilitating symptom experienced by up to 90% of the nearly 3 million people with MS worldwide, with nearly half describing it as their worst symptom. This study provides valuable insights into effective strategies for managing this challenging aspect of the disease.
