UK Study: Fatigue Often Influences Quality of Life in MS

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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Fatigue is a common symptom among people living with multiple sclerosis (MS), and has a significant negative impact on physical and psychological function, as well as quality of life, a U.K. study reported.

Citing the study as the “largest study on fatigue in MS from U.K.,”  researchers emphasized that the findings support a need for “further research into mechanisms of MS related fatigue and its mitigation.”

The study, “Fatigue in Multiple Sclerosis: A UK MS-Register based study,” was published in Multiple Sclerosis and Related Disorders

Fatigue, defined as mental or physical exhaustion that affects a person’s daily functioning, is widely experienced by MS patients and linked to significant impairments in daily functioning and early retirement.

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Fatigue in MS may be grouped into two main categories. Primary fatigue is a direct consequence of the nerve cell damage induced by MS, and is characterized by sudden, severe episodes that are aggravated by heat and humidity and unaffected by restful sleep. In contrast, secondary fatigue is an indirect consequence of other MS symptoms or medications.

In an effort to better understand the symptom’s prevalence and impact in the U.K., a research team examined data from 775 participants in the U.K. MS Register. Their mean age was 54.7 years and they had been living with the condition for an average of 13.2 years.

Most participants had relapsing-remitting MS (59.6%), while 20.5% had secondary progressive MS, and 16.9% had primary progressive MS. The disease type was unknown in 3% of people.

A majority of participants (507) were not using disease-modifying therapies.

Responses to the fatigue severity scale (FSS) questionnaire indicated that 427 people (55.1%) had an FSS score greater than 5, meeting the criteria for fatigue. Patients with fatigue had a significantly longer disease duration and a greater level of MS-associated disability than those without fatigue.

Fatigued patients also had higher scores on the Hospital Anxiety and Depression Scale (HADS), reflecting a greater degree of self-reported anxiety and depression.

The researchers then conducted a statistical analysis to determine which factors were most associated with fatigue. They determined that disease duration, greater disability, depression, and a secondary progressive MS type were significant predictors of fatigue in this group of patients.

The findings suggest that “clinicians should proactively look for fatigue” in patients with those characteristics, the researchers wrote.

Additional findings showed that higher FSS scores had a significant negative impact on quality of life, on the psychological and physical domains of the MS impact scale, as well as on the MS walking scale. Together, these associations indicated that fatigue adversely affects psychological and physical well-being, the researchers noted.

“The influence of fatigue on quality of life highlights the need to understand this problem better and develop cost effective solutions,” the researchers wrote.

As fatigue has been cited as the most common reason for MS patients to leave their employment, a future investigation collecting employment data may be warranted.

Additional studies evaluating the effects of MS treatments on fatigue also should be a direction for future investigations, the researchers noted.

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