Saturday, 18 June 2011

The positive effect of CBT on fatigue in patients with MS

Knoop et al. Psychol Med. 2011 Jun 15:1-9. [Epub ahead of print]

Chronic fatigue is a major problem in MS; it's the commonest symptom PwMS complain about (~85%) and in patients with fatigue ~50% claim it be their most disabling symptom. A randomized controlled trial has shown that cognitive behavioural therapy (CBT) is more effective in reducing MS fatigue than relaxation training (RT). This study analysed additional data from this trial . Results: avoidance behaviour and three cognitive variables (symptom focusing, believing symptoms are a sign of damage and a negative representation of fatigue) improved significantly more in the CBT than the RT group. Changing negative representations of fatigue mediated the decrease in severity of fatigue. Conclusions: Change in beliefs about fatigue play a crucial role in CBT for MS-related fatigue.

"If you suffer from severe MS-related fatigue you should look into CBT; some of my patients have had good responses. This paper attempts to define which patients are likely to respond to CBT. I wish we knew more about MS-related fatigue; I would rate the treatment of MS-related fatigue as one of the biggest unmet needs in MS. Do you agree?"

6 comments:

  1. Re: "I would rate the treatment of MS-related fatigue as one of the biggest unmet needs in MS. Do you agree?"

    I'd say MS-related issues to do with walking and balance are a bigger unmet need.

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  2. I agree with your other poster - being fatigued dwindles in importance in comparison with not being able to walk/balance. However if it is a symptom that can be 'helped' then attention should be paid to it as it could help many people.

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  3. Yes, I would rather work was done to improve my balance and walking. Fatigue I can handle.

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  4. Ditto the above about balance/walking.

    The list of symptoms with this disease really differentiates it from other disease. A friend with ME moans about their fatigue, but once I've ran through the long list of MS symptoms they wouldn't stop.

    Rather than symptomatic treatments I'd rather have an holistic approach i.e.a treatment which stopped the tissue damage and therefore impacted on all symptoms. This would also address the worse symptom - a fear of what MS will do in the future.

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  5. CBT and counselling are not addressing the real disease (just trying to convince you it's not that bad). If a treatment made my disease inactive (no relapses / no progression), I would sleep better, my mood would be better, I'd have the confidence to go out more, I would exercise etc etc. Just want to be like some cancer patients and told that I am in remission. If I heard this many of my sympoms would feel much better.

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  6. If I just had my balance/walking issues (I'm a wheelchair user), I would still be working full time. It's the fatigue that stops me doing so. MS fatigue is crippling in a very real way, and I would welcome anything that helps me to deal with it more easily.

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