Fatigue is one of the most pervasive and challenging symptoms faced by individuals with multiple sclerosis (MS), affecting up to 90% of patients at some point in their lives. Nearly half of these individuals consider fatigue to be their most debilitating symptom.
In light of this, researchers have explored the effectiveness of various treatments, discovering that cognitive behavioral therapy (CBT) may be just as effective as medication in alleviating this symptom.
A groundbreaking study recently published in The Lancet Neurology highlights the comparative effectiveness of CBT, the medication modafinil, and a combination of the two. The findings have significant implications for treatment approaches to managing MS fatigue.
The Study: Comparing Treatments for MS Fatigue
Researchers conducted a 12-week study with 336 participants, all of whom were living with MS. Participants were asked to rate their fatigue levels at the start of the study and again at the conclusion. The scientists focused on three specific interventions:
- Cognitive Behavioral Therapy (CBT): A structured form of talk therapy that helps individuals identify and challenge negative thought patterns, promoting healthier responses to fatigue.
- Modafinil (Provigil): A mild stimulant commonly prescribed for sleep disorders such as narcolepsy, sleep apnea, and shift work-related sleep issues.
- Combination Therapy: A blend of CBT and modafinil.
By the end of the study, participants in all three groups experienced similar reductions in fatigue, with each approach offering clinically meaningful improvements.
These findings demonstrate the potential of both behavioral and pharmacological treatments to improve the quality of life for people with MS.
A Leader’s Perspective on the Findings
“Fatigue is one of the most common and debilitating symptoms of multiple sclerosis, yet there is still uncertainty about how available treatments should be used or how medication-based treatments compare to behavioral treatments in the real world,” stated Tiffany Braley, MD,, lead author of the study and associate professor of neurology at the Michigan Neuroscience Institute and the University of Michigan in Ann Arbor.
“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,” Dr. Braley added.
Key Results: Effectiveness and Side Effects
The study revealed that 65% of participants using CBT, 69% taking modafinil, and 70% on combination therapy reported “clinically meaningful” reductions in fatigue.
While these numbers indicate a positive impact on patients’ daily lives, the differences between the groups were not statistically significant. This means that the observed changes could have occurred by chance.
An important advantage of CBT was its lack of side effects. In contrast, modafinil was associated with common side effects such as insomnia and anxiety. This distinction might make CBT a preferable option for patients who are sensitive to medication-related complications.
Cognitive Behavioral Therapy: A Holistic Approach to Fatigue
CBT offers a unique way to tackle MS fatigue by addressing the interplay between thoughts, emotions, and behaviors. Bardia Nourbakhsh, MD, an associate professor of neurology at Johns Hopkins University, explains the benefits of CBT:
“CBT helps patients with multiple sclerosis to identify connections between their thoughts, emotions, and behaviors, especially those patterns that may be exacerbating their fatigue. This approach empowers individuals to develop new strategies to manage their energy, adjust unhelpful thoughts, and create healthier habits for handling fatigue,” Dr. Nourbakhsh noted.
While the study demonstrates CBT’s effectiveness, it also raises questions about whether the benefits stem from the structured therapy itself or simply from the opportunity to speak with a supportive therapist.
Modafinil: A Pharmacological Alternative
For patients experiencing both fatigue and excessive daytime sleepiness, modafinil may offer additional benefits. Doses of modafinil varied significantly among study participants, reflecting the individualized nature of its effectiveness. Dr. Nourbakhsh elaborates:
“Overall, in the absence of a study that shows medication is clearly better than a placebo in improving multiple sclerosis fatigue, I would recommend nonmedication approaches, such as CBT. However, in patients who have concomitant daytime sleepiness, I recommend being tested for sleep apnea or other sleep disorders. If there is no sleep disorder, or if fatigue and daytime sleepiness remain after treating the sleep disorder, modafinil might be a good option in this case.”
The Role of Non-Medication Approaches
For many patients, CBT may represent a safer and equally effective alternative to medication. It equips individuals with tools to better understand and manage their fatigue, fostering long-term resilience. Importantly, it avoids the potential side effects associated with pharmacological interventions.
Implications for MS Treatment
This study underscores the importance of offering diverse treatment options for MS fatigue. Both CBT and modafinil show promise, but their effectiveness may vary based on individual circumstances, such as the presence of concurrent sleep disorders.
By demonstrating that behavioral therapy can match the benefits of medication, this research paves the way for a more personalized and holistic approach to managing MS fatigue. For patients, this means more flexibility in choosing treatments that align with their preferences, medical history, and lifestyle.
In the words of Dr. Braley, this study provides “new evidence” to guide treatment approaches for one of the most challenging symptoms of MS. Whether through talk therapy or medication, individuals now have multiple paths to reclaiming their energy and improving their quality of life.
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