Let’s talk about MS fatigue and the effectiveness of treatment options

Here's a look at cognitive behavioral therapy and modafinil in easing fatigue

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by Ed Tobias |

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Want to reduce your multiple sclerosis (MS) fatigue? Maybe we should talk about it.

I’m talking about a fatigue treatment called cognitive behavioral therapy (CBT), which usually involves changing a person’s thinking and behavior. By talking with a therapist, sometimes on the phone, a patient develops an understanding of the problem and a strategy to address it. Simply put, modifying how we think about a problem affects how we solve it.

A strategy to fight MS fatigue

How can CBT help to ease our MS fatigue? A 2017 study published in the Journal of Psychosomatic Research reported that if a person with MS focused on improving their thinking about things such as physical activity, daytime sleepiness, feelings of helplessness, and physical functioning, fatigue levels could be lowered.

Of course, medication can also be used to address fatigue. I’ve used Provigil (modafinil) for many years, with mixed results. I think that the efficacy of the drug can wane over time, at least that’s what happened with me. After many years of using modafinil, I stopped receiving the same boost that it once gave me. But after going off it for a few months, its usefulness returned when I started taking it again, with positive results.

Now, if both of these fatigue-fighting approaches work, at least to some extent, what might be the result if they were combined?

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A study looks at CBT and modafinil 

Researchers at the University of Michigan recently looked at the effect on MS fatigue of CBT alone, modafinil alone, and a combination of the two, as MS News Today’s Marisa Wexler recently reported. In the study — whose results were shared at this year’s Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) conference in San Diego, California, in late February — 336 people with MS who were diagnosed with clinical fatigue were placed in three groups and randomized to receive either 50-200 mg of modafinil twice a day, CBT via telephone, or a combination of the two, for 12 weeks. (My modafinil dose has been 100 mg daily.)

The effect on fatigue was similar for each of the three groups. Scores on the Modified Fatigue Impact Scale were reduced by 16.9 points for people treated with modafinil alone, 15.2 points for CBT alone, and 17.3 for those in the combination group. That’s all considered clinically significant.

But when judged on the Patient Global Impression of Change scale — which measures how a patient perceives the impact of treatment on their quality of life — the patients who received a combination of CBT and modafinil generally perceived that they had seen increased benefits to their overall health and well-being.

So does it really matter if you’re treated with modafinil, CBT, or both? Probably not. But as some people say, perception is reality.

If you have an opinion on this issue, please share it in the comments below. You’re also invited to visit my personal blog at www.themswire.com.

Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to multiple sclerosis.


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