• Posted October 25, 2024

What Works Best to Ease MS-Linked Fatigue? New Study Finds Out

Medication and behavioral therapy are both effective in combatting fatigue caused by multiple sclerosis (MS), either separately or together, a new study finds.

MS patients felt significantly less fatigue after they were prescribed modafinil (Provigil), a drug that promotes wakefulness and is used to treat sleepiness, researchers reported recently in The Lancet Neurology journal.

Patients also reported less fatigue after they were given cognitive behavioral therapy (CBT), in which they were taught to recognize the factors that make their fatigue symptoms worse or better.

Combining the two treatments, drugs and therapy, provided about the same results as either on their own.

However, a person's own sleep habits also played a role in whether one or the other would work better, researchers discovered.

“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 lead researcher Dr. Tiffany Braley, director of the University of Michigan Health’s Multiple Sclerosis/Neuroimmunology Division.

As many as 90% of the nearly 3 million people with MS worldwide experience fatigue, and nearly half describe it as their worst symptom.

For this study, researchers randomly assigned nearly 340 patients to either undergo CBT, take modafinil, or use both.

More than 60% of participants in each group reported clinically meaningful improvement in their fatigue, results showed.

“These treatments, both individually and as a combination, should be considered as potential options for people with multiple sclerosis with chronic, problematic fatigue,” said senior researcher Anna Kratz, a professor of physical medicine and rehabilitation at the University of Michigan Medical School.

In particular, the study highlights the potential benefits of cognitive behavioral therapy, researchers noted.

“While many people with multiple sclerosis have limited access to behavioral health care like CBT, offering the treatment through telehealth can help reach more patients,” Kratz said in a university news release.

“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 added.

People with poor sleep hygiene tended to have better fatigue outcomes when using cognitive-behavioral therapy, results showed.

On the other hand, participants with very good sleep hygiene had better fatigue improvement with modafinil, researchers said.

“Using wake-promoting medications such as modafinil could worsen sleep quality in patients whose sleep problems are behavioral in nature,” Braley explained. 

“As sleep disturbances also contribute to fatigue in people with MS, it is important to avoid selecting fatigue treatments that could make sleep worse,” Braley added. “Behavioral treatments such as CBT that include sleep education may be preferable for people with MS who have poor sleep habits.”

More information

The National Multiple Sclerosis Society has more on fatigue and MS.

SOURCE: University of Michigan, news release, Oct. 17, 2024