Managing fatigue in patients with multiple sclerosis
Carolyn M. Johnson MSN, RN, CNL, CNRN

June 2012 
Volume 42  Number 6
Pages 26 - 29
  PDF Version Available!

MULTIPLE SCLEROSIS (MS) is the most common autoimmune inflammatory demyelinating disease of the central nervous system with signs and symptoms that include weakness, bladder and bowel problems, depression, and memory loss.1,2 However, the most common symptom is fatigue, which is reported by 70% to 90% of patients with MS.3 Fatigue can decrease the quality of life for patients with MS, but it can be managed with proper treatment. This article will take a look at fatigue as it's experienced by patients with MS and discuss how it can be managed.A subjective concept, fatigue is difficult to define. The Multiple Sclerosis Council for Clinical Practice Guidelines defines fatigue as "a subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities."4 Fatigue is personal and can be truly defined only by the individual experiencing it. The severity of fatigue is what the patient perceives it to be.5As nurses, we may be tempted to assess a patient's fatigue based on comparison to other patients of similar age and gender who also have MS. This may lead to a misrepresentation of the degree of fatigue that the patient feels. Many patients rate their fatigue severity based on their activity level before being diagnosed with MS.5 Patients may have a baseline level of fatigue due to other underlying conditions such as anemia, thyroid abnormalities, liver dysfunction, or sleep disorders.5,6 Over half of patients with MS report that fatigue is their most frustrating symptom and the main reason for social isolation and inability to work.3Fatigue can be divided into two categories, primary and secondary. Primary fatigue is caused by the MS disease process as the patient progresses through the course of the disease. Secondary fatigue is caused by factors associated with MS progression and treatment, such as depression, adverse reactions to medications, sleep disturbances, and infections.6When determining how

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