This practical guide for physicians and other health care
professionals discusses the impact of fatigue on the individual
with MS, the potential etiologies underlying MS-related fatigue,
its work up and diagnosis, and pharmacologic and nonpharmacologic
management strategies.
Fatigue is perhaps the single most prevalent and disabling
symptom of the multiple sclerosis, and limits patients' activity
more than any other MS symptom. The identification of fatigue as a
distinct clinical entity requires both art and science, and most of
all, a willingness and ability to listen carefully to patients and
their families. The physician's ability to obtain a comprehensive
history requires a full understanding of the circumstances in which
fatigue occurs (physical, cognitive, and psychosocial) and demands
consideration of a large number of disorders, including anxiety,
depression, excessive daytime sleepiness, pain, and spasticity, all
of which may mimic or contribute to fatigue.
While fatigue is almost exclusively a subjective experience,
depending on the patient's ability to understand and report this
symptom, there are effective methods for identifying the existence
of fatigue, determining its severity, and distinguishing it from
related or contributing disorders such as depression, pain, and
sleep disorders.
Readers will learn that fatigue need not be tolerated by the MS
patient. Various therapies, support systems, and treatment of
underlying affective disorders can all alleviate fatigue or reduce
its impact, restoring the patient's energy levels and ability to
participate in life. Virtually every MS patient with fatigue can
benefit from intervention, and failing to treat the symptom of
fatigue with the respect that it deserves is a serious detriment to
patient care.
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