Fatigue in multiple sclerosis: A scoping review of pharmacological and nonpharmacological interventions

Introduction: Fatigue is a highly prevalent symptom in people with multiple sclerosis. It demands careful assessment and prompt intervention to improve their quality of life and overall burden of disease. This scoping review aims to provide a comprehensive synthesis and update of the existing evidence on the effectiveness of different pharmacological and nonpharmacological interventions for multiple sclerosis (MS)-related fatigue. Methods: To ensure the transparency and quality of the articles chosen for this scoping review, the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols extension for Scoping Reviews was used. Exclusively randomized controlled trials published between 2016 and 2023 were included. Results: Twenty-eight articles were analyzed. We found that pharmacological interventions are few and have included the use of Amantadine, Ondansetron, Methylphenidate, and Modafinil, with little effects on fatigue. Nonpharmacological interventions are diverse and include cognitive behavioral therapy, guided imagery, phototherapy, exercise, brain stimulation, and lavender administration with evidence of a statistically significant decrease in fatigue. Conclusions and Discussion: Current evidence on the effectiveness of pharmacological and nonpharmacological interventions is inconclusive. Lack of knowledge of the pathophysiology of fatigue limits its prevention, control, and management recommendations. A comprehensive and interdisciplinary approach is required to manage this symptom in patients with MS.