Journal of Isfahan Medical School

Journal of Isfahan Medical School

Interventions and Effective Strategies in Managing Fatigue in Patients with Multiple Sclerosis: A Review Study

Document Type : Review Article (s)

Authors
Alireza Hasan zadeh Sureshjani 1
Alireza Seyfiardali 2
Reza Ahmadi Deh Kohneh 1
Amir Hossein Aghaei 3
Alireza Hashemi Shahreki 1
Fatemeh Aliakbari 4
1 Nursing Student, Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
2 MSc Student in Medical-Surgical Nursing, Student Research Committee, Najafabad Branch, Islamic Azad University, Najafabad, Iran
3 Medical Student, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
4 Associate Professor, Department of Nursing, Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
10.48305/jims.v44.i850.0124
Abstract
Background: Fatigue is one of the most disabling and common symptoms in patients with Multiple Sclerosis (MS). In the context of this narrative review, efforts have been directed to establish effective non-pharmacologic, pharmacologic, and nursing intervention in the management of MS fatigue
Methods: A comprehensive search across various databases was conducted using customized strategies and keywords for each platform. Articles satisfying the inclusion criteria up to 2024 were included, and 58 appropriate articles were included in this narrative review.
Findings: It was found that non-pharmacologic interventions included physiotherapy, regular exercise, psychological counseling, sleep management, and healthy nutrition,. Pharmacologic approaches such as use of stimulants and antidepressants were also found to be effective in minimizing fatigue.
Conclusion: Fatigue has been defined legally as decreased capacity to do after effort or mental and is very prevalent among MS patients. Fatigue Severity Scale (FSS), Fatigue Impact Scale (FIS), and Unidimensional Fatigue Impact Scale (U-FIS) are the most frequently used fatigue rating scales. Amantadine, fampridine, aspirin, modafinil, and methylphenidate are usually prescribed by physicians to reduce fatigue in MS patients. The patient needs to be taught by the nurses regarding the potential side effects and needs to be watched carefully. Music therapy, meditation, yoga, sleep hygiene, subsequently followed strictly by diet by it, and depression and stress management are some of the non-pharmacologic measures that also diminish the fatigue. Intervention for fatigue and studies of the effect of nursing intervention on long-term MS patient alleviation of fatigue are definitely the cry of the day.

Highlights

Alireza Hasanzadeh Soureshjani:  Google Scholar , PubMed

Reza Ahmadi Dehkohneh: PubMed

lireza Hashemi Shahraki: PubMed

Keywords
Fatigue
Disease management
Therapeutics
Multiple sclerosis

Subjects

1.     Qomi M, Rakhshan M, Ebrahimi Monfared M, Khademian Z. The effect of distance nurse-led fatigue management on fatigue, sleep quality, and self-efficacy in patients with multiple sclerosis: a quasi-experimental study. BMC Neurol. 2023; 23(1): 71.
2.     Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et al. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS. third edition. Mult Scler 2020; 26(14): 1816-21.
3.     Sahraian MA, Sahebkar M, Dehghani R, Derakhshan-Jazari M, Kazami-Moghaddam V, Kouchaki E. Multiple sclerosis-A disease on a dramatically rising trend in Iran: Review of possible reasons. Iran J Neurol. 2017; 16(1): 34-40.
4.     Asmarian N, Sharafi Z, Mousavi A, Jacques R, Tamayo I, Bind MA, et al. Multiple sclerosis incidence rate in southern Iran: a Bayesian epidemiological study. BMC Neurol 2021; 21(1): 309.
5.     López-Muñoz P, Torres-Costoso AI, Fernández-Rodríguez R, Guzmán-Pavón MJ, de Arenas-Arroyo SN, Basco-López J, et al. Effect of Vitamin D Supplementation on Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Nutrients 2023; 5(13): 2861.
6.     Ruiz-Rizzo AL, Bublak P, Kluckow S, Finke K, Gaser C, Schwab M, et al. Neural distinctiveness of fatigue and low sleep quality in multiple sclerosis. Eur J Neurol 2022; 29(10): 3017-27.  
7.     Kamudoni P, Johns J, Cook KF, Salem R, Salek S, Raab J, et al. Measuring fatigue in people with multiple sclerosis - which questionnaire should be used? A Plain Language Summary of Publication. Neurodegener Dis Manag 2024; 14(1): 5-9.
8.     Wolf F, Folkerts AK, Zimmer P, Nielsen J. Experiences of fatigued persons with multiple sclerosis with multimodal agility-based exercise training and the ReFEx study protocol: a qualitative extension of a feasibility study. BMJ Open 2024; 14(2): e076333.
9.     Mousavi-Shirazi-Fard Z, Mazloom Z, Izadi S, Fararouei M. The effects of modified anti-inflammatory diet on fatigue, quality of life, and inflammatory biomarkers in relapsing-remitting multiple sclerosis patients: a randomized clinical trial. Int J Neurosci 2021;131(7): 657-65.
10.  Riccitelli GC, Disanto G, Sacco R, Sparasci D, Sacco L, Castelnovo A, et al. Contribution of sleep disturbances to fatigue in multiple sclerosis: a prospective study using clinical and polysomnographic parameters. Eur J Neurol 2021; 28(9): 3139-46.
11.  Schwid SR, Covington M, Segal BM, Goodman AD. Fatigue in multiple sclerosis: current understanding and future directions. J Rehabil Res Dev 2002; 39(2): 211-24.
12.  Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46(10): 1121-3.
13.  Ghotbi N, Ansari NN, Fetrosi S, Shamili A, Choobsaz H, Montazeri H. Fatigue in Iranian patients with neurological conditions: An assessment with Persian Fatigue Severity Scale. Health Sci J 2013; 7(4): 395-402.
14.  Al-Sobayel HI, Al-Hugail HA, AlSaif RM, Albawardi NM, Alnahdi AH, Daif AM, et al. Validation of an Arabic version of fatigue severity scale. Saudi Med J 2016; 37(1): 73-8.
15.  Gavrilov YV, Shkilnyuk GG, Valko PO, Stolyarov ID, Ivashkova EV, Ilves AG, et al. Validation of the Russian version of the Fatigue Impact Scale and Fatigue Severity Scale in multiple sclerosis patients. Acta Neurol Scand 2018;1 38(5): 408-16.
16.  Salehpoor G, Rezaei S, Hoseinizadeh M. Psychometric properties of fatigue severity scale in patients with multiple sclerosis [in persian]. J kerman Univ Med Sci 2013; 20(3): 263-78.
17.  Fisk JD, Ritvo PG, Ross L, Haase DA, Marrie TJ, Schlech WF. Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. Clin Infect Dis 1994; 18(Suppl 1): S79-S83.
18.  Heidari M, Nabavi SM, Akbarfahimi M, Salehi M, Torabi-Nami M. Psychometric properties of the Persian version of the Fatigue Impact Scale (FIS-P) in patients with Multiple Sclerosis. Iranian Rehabilitation Journal 2015; 13(3): 32-8.
19.  Losonczi E, Bencsik K, Rajda C, Lencsés G, Török M, Vécsei L. Validation of the Fatigue Impact Scale in Hungarian patients with multiple sclerosis. Qual Life Res 2011; 20(2): 301-6.
20.  Meads D, Doward L, McKenna S, Fisk J, Twiss J, Eckert B. The development and validation of the Unidimensional Fatigue Impact Scale (U-FIS). Mult Scler 2009; 15(10): 1228-38.
21.  Doward LC, Meads DM, Fisk J, Twiss J, Hagell P, Oprandi NC, et al. International Development of the Unidimensional Fatigue Impact Scale (U‐FIS). Value Health 2010; 13(4): 463-8.
22.  Khazaei M, Karevan A, Taheri M, Ghafouri-Fard S. Comparison of the effects of amantadine and ondansetron in treatment of fatigue in patients with multiple sclerosis. Clin Transl Med 2019; 8: 20.
23.  Nourbakhsh B, Revirajan N, Morris B, Cordano C, Creasman J, Manguinao M, et al. Safety and efficacy of amantadine, modafinil, and methylphenidate for fatigue in multiple sclerosis: a randomised, placebo-controlled, crossover, double-blind trial. Lancet Neurol 2021; 20(1): 38-48.
24.  Ferorelli P, Antonelli F, Shevchenko A, Mischiati C, Doepp M, Lenzi S, et al. Reduction in Fatigue Symptoms Following the Administration of Nutritional Supplements in Patients with Multiple Sclerosis. Med Sci (Basel) 2021; 9(3): 52.
25.  Generali JA, Cada DJ. Amantadine: multiple sclerosis-related fatigue. Hosp Pharm 2014; 49(8): 710-2.
26.  Rezaian Langroudi R, Ghiasian M, Roozbehani M, Shamsaei F. Comparison of the Effectiveness of Group Therapy Based on Acceptance and Commitment and Amantadine on Pain, Fatigue and Quality of Life in Patients with Multiple Sclerosis [in Persian]. Avicenna J Nurs Midwifery Care 2020; 28(3): 251-62.
27.  Fryml LD, Williams KR, Pelic CG, Fox J, Sahlem G, Robert S, et al. The role of amantadine withdrawal in 3 cases of treatment-refractory altered mental status. J Psychiatr Pract 2017; 23(3): 191-9.
28.  Marxreiter F, Winkler J, Uhl M, Madžar D. A case report of severe delirium after amantadine withdrawal. Case Rep Neurol 2017; 9(1): 44-8.
29.  Kunieda K, Shigematsu T, Fujishima I. Case reports describing amantadine intoxication in a rehabilitation hospital. Prog Rehabil Med 2017; 2: 20170017.
30.  Şahan E, Bölükbaşı Ö. Modafinil intoxication induced persistent psychosis: case report. Psychiatr Danub 2019; 31(3): 369-70.
31.  Luca CC, Nadayil G, Dong C, Nahab FB, Field-Fote E, Singer C. Dalfampridine in Parkinson's disease related gait dysfunction: A randomized double blind trial. J Neurol Sci 2017; 379: 7-11.
32.  Epifanio M, Portela JL, Piva JP, Ferreira CHT, Sarria EE, Mattiello R. Bromopride, metoclopramide, or ondansetron for the treatment of vomiting in the pediatric emergency department: a randomized controlled trial. J Pediatr (Rio J) 2018; 94(1): 62-8.
33.  Shaygannejad V, Janghorbani M, Ashtari F, Zakeri H. Comparison of the effect of aspirin and amantadine for the treatment of fatigue in multiple sclerosis: a randomized, blinded, crossover study. Neurol Res 2012; 34(9): 854-8.
34.  Hsu PI, Tsai TJ. Epidemiology of Upper Gastrointestinal Damage Associated with Low-Dose Aspirin. Curr Pharm Des 2015; 21(35): 5049-55.
35.  Taul-Madsen L, Hvid LG, Sellebjerg F, Christensen JR, Ratzer R, Sejbæk T, et al. Study protocol: effects of exercise booster sessions on preservation of exercise-induced adaptations in persons with multiple sclerosis, a multicentre randomised controlled trial-the MS BOOSTER trial. BMJ Open 2024; 14(8): e085241.
36.  Jeng B, Cederberg KLJ, Huynh TL, Silic P, Jones CD, Feasel CD, et al. Social Cognitive Theory variables as correlates of physical activity in fatigued persons with multiple sclerosis. Mult Scler Relat Disord 2022; 57: 103312.
37.   Sparasci D, Gobbi C, Castelnovo A, Riccitelli GC, Disanto G, Zecca C, et al. Fatigue, sleepiness and depression in multiple sclerosis: defining the overlaps for a better phenotyping. J Neurol 2022; 269(9): 4961-71.
38.  Toscano VG, Coelho FM, Prado GFD, Tufik S, Oliveira EML. Sleep disorders in multiple sclerosis: a case-control study using the São Paulo Epidemiologic sleep study (Episono) database. Arq Neuropsiquiatr 2022; 80(8): 822-30.
39.  Lin X, Zarghami A, Jelinek GA, Simpson-Yap S, Neate S, Nag N. Diet and omega-3 and vitamin D supplement use predict five-year fatigue and disability trajectories in people with multiple sclerosis. Mult Scler Relat Disord 2024; 86:105615.
40.  Gaballah S, El-Deen DS, Hebeshy MI. Effect of effleurage massage therapy on sleep disturbance, fatigue, pain, and anxiety in patients with multiple sclerosis: A quasi-experimental study. Appl Nurs Res 2023; 73: 151719.
41.  Ashtiani AR, Seied Amirhossein L, Jadidi A, Ghasami K, Khanmohamadi Hezave A, Aghae Pour SM, et al. The effect of novel simple saffron syrup on fatigue reduction in patients with multiple sclerosis. J Basic Clin Physiol Pharmacol 2020; 31(6).
42.  Nag N, Yang X, Jelinek G, Neate S, Simpson-Yap S. Undertaking specific stress-reducing activities are associated with reduced fatigue and depression, and increased mastery, in people with multiple sclerosis. Mult Scler Relat Disord 2022; 62: 103804.
43.  Reece JC, Neate SL, Davenport RA, Milanzi E, Nag N, Bevens W, et al. Stressful life events and depression and fatigue in people with multiple sclerosis: a cross-sectional analysis of an international cohort. Acta Neurol Belg 2024; 124(2): 457-66.
44.  Schließeit J, Oertel FC, Cooper G, Brandt AU, Bellmann-Strobl J. Longitudinal analysis of primary and secondary factors related to fatigue in multiple sclerosis. Acta Neurol Belg 2021; 121(1): 271-4.
45.  Amato MP, Portaccio E. Management options in multiple sclerosis-associated fatigue. Expert Opin Pharmacother 2012; 13(2): 207-16.
46.  Asano M, Finlayson ML. Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Mult Scler Int 2014; 2014: 798285.
47.  Abd’Elamgied Salime RA, Ibrahiem Elzehiri DA, Ibrahim RAS. Effect of Nursing Intervention on Fatigue for Multiple Sclerosis Patients. Tanta Scientific Nursing Journal 2022; 24(1): 200-23.
48.  Halper J. The psychosocial effect of multiple sclerosis: the impact of relapses. J Neurol Sci 2007; 256(Suppl 1): S34-8.
49.  Kalb R. The emotional and psychological impact of multiple sclerosis relapses. J Neurol Sci 2007;256(Suppl 1): S29-33.
50.  Ross AP, Halper J, Harris CJ. Assessing relapses and response to relapse treatment in patients with multiple sclerosis: a nursing perspective. Int J MS Care 2012; 14(3): 148-59.
51.  Gil-González I, Martín-Rodríguez A, Conrad R, Pérez-San-Gregorio M. Quality of life in adults with multiple sclerosis: a systematic review. BMJ Open 2020; 10(11): e041249.
52.  Kooshiar H, Moshtagh M, Sardar MA, Foroughipour M, Shakeri MT, Vahdatinia B. Fatigue and quality of life of women with multiple sclerosis: a randomized controlled clinical trial. J Sports Med Phys Fitness 2015; 55(6): 668-74.
53.  Nagaraj K, Taly AB, Gupta A, Prasad C, Christopher R. Prevalence of fatigue in patients with multiple sclerosis and its effect on the quality of life. J Neurosci Rural Pract 2013; 4(3): 278-82.
54.  NICE Evidence Reviews Collection. Evidence reviews for coordination of care: the role of MS nurse specialists and other healthcare professionals: Multiple sclerosis in adults: management: Evidence review B. London: National Institute for Health and Care Excellence (NICE); 2022.
55.  Halper J. The evolving role of the nurse in the treatment of multiple sclerosis. Journal of Neuroscience Nursing 2009; 41(4): E1-E13.
56.  Witzig-Brändli V, Lange C, Gschwend S, Kohler M. "I would stress less if I knew that the nurse is taking care of it": Multiple Sclerosis inpatients' and health care professionals' views of their nursing-experience and nursing consultation in rehabilitation-a qualitative study. BMC Nurs 2022; 21(1): 232.
57.  Brenner R, Witzig-Brändli V, Vetsch J, Kohler M. Nursing Interventions Focusing on Self-efficacy for Patients With Multiple Sclerosis in Rehabilitation: A Systematic Review. Int J MS Care 2022; 24(4): 189-98.
Heidari-Soureshjani R, Nasrabadi AN, Zakerimoghadam M, Mohammadi T, Rasti A. Self-management interventions for people with multiple sclerosis: A systematic review and meta-analysis protocol. Health Sci Rep 2023; 6(9): e1536
Journal of Isfahan Medical School
Volume 44, Issue 850
2nd Week, April
March and April 2026
Pages 124-133

  • Receive Date 09 March 2025
  • Accept Date 31 January 2026