Fatigue in relapsing-remitting MS linked to pain, sleep, stress, study finds

MS fatigue was associated with pain, sleep problems, stress, anxiety and depression in people with relapsing-remitting disease, a study found.

Greater disability and walking difficulties were also linked to more severe fatigue among people with mild to moderate disability.

The findings suggest assessments may need to consider factors associated with fatigue as well as the severity of the symptom itself.

“Recognising and addressing these interrelated factors is essential to improving fatigue management and, ultimately, enhancing the quality of life for individuals living with MS [multiple sclerosis],” they wrote.

“Comprehensive assessment using the CFAB-MS may facilitate the identification of modifiable factors contributing to fatigue and support more personalized therapeutic decision-making.”

A research team in Iran used the Comprehensive Fatigue Assessment Battery for Multiple Sclerosis, or CFAB-MS, to examine fatigue and related factors in 123 people with relapsing-remitting multiple sclerosis.

The questionnaire assesses fatigue, pain, sleep, stress, mood, nutrition, mobility, environmental factors and fatigue management strategies.

Participants had reported fatigue and had mild or moderate disability, defined as an Expanded Disability Status Scale score below four.

Their mean age was 34.12 years and 74.8 per cent were women. Participants had been living with MS for a median of five years and had a median disability score of one.

The most common initial symptoms were blurred vision in women, reported by 34.8 per cent, and sensory problems in men, reported by 41.9 per cent.

The most commonly used disease-modifying therapy was dimethyl fumarate, used by 35.8 per cent, followed by fingolimod and rituximab, each used by 14.6 per cent.

Anxiety and worry, fatigue and stress were the most commonly reported health problems, while walking difficulties were the least reported. Anxiety and worry, as well as stress, were significantly more severe in women than men.

Nearly half, 47.2 per cent, reported experiencing fatigue for more than six months.

One-third experienced fatigue occasionally, while 25.2 per cent reported it on most days and 23.6 per cent experienced it daily.

A higher proportion of participants reported fatigue lasting less than three hours per day. Fatigue most commonly began in the morning and worsened during the late evening.

Pain interfered with several areas of daily life, while sleep disturbances were also common.

Night-time urination was the most frequently reported sleep-disrupting factor, affecting 52 per cent of participants.

Restless legs syndrome was reported by 26.8 per cent, morning headaches by 26 per cent and sleep apnoea by 7.3 per cent.

Sleep apnoea is a condition in which breathing repeatedly stops and starts during sleep.

Heat was another commonly reported factor, with 70.7 per cent saying it worsened their fatigue and 61 per cent reporting increased energy after leaving a hot environment.

Higher disability scores were significantly associated with greater fatigue, pain, stress, anxiety and walking difficulties.

More severe fatigue was also significantly associated with more severe pain, depression, anxiety, sleep problems and walking difficulties.

The physical, psychological and social fatigue index was also associated with all components of the questionnaire’s general health domain.

Researchers said the findings support a broader approach to assessing and managing fatigue in relapsing-remitting MS.

The researchers said fatigue management may involve medication alongside structured exercise, dietary therapy, cognitive behavioural therapy, energy conservation, sleep optimisation and treatment of depression, anxiety and pain.

However, the study’s cross-sectional design means it cannot establish cause and effect or determine which factors were independently associated with fatigue.

The researchers also reported poor reliability in some measures of sleep, mood and pain.