Fatigue in MS Patients

Cognitive-Behavioral Therapy Improves Fatigue in MS Patients

Pauline Anderson

May 31, 2014

DALLAS ― Fatigue, often linked to insomnia, is one of the most common complaints of patients with multiple sclerosis (MS), so anything that controls this debilitating condition would be a welcome relief.

Cognitive-behavioral therapy (CBT), a psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence their behaviors, appears to be a viable option. A small, new study showed that it increases sleep time and reduces fatigue and depression in MS patients suffering insomnia.

It is hard to tease out whether the intervention first has an effect on the fatigue or on the depression and then perhaps has a kind of snowball effect, said lead author Megan Clancy, PhD, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, in Ohio.

"We don't know if it's the chicken or the egg," Dr. Clancy said, that is, whether the problem with insomnia started with depression or with fatigue, and then made the other problem worse. In any case, CBT appears to work on both.

Dr. Clancy discussed the data at a poster presentation here at the 6th Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS).

Chicken or Egg

According to a recent survey of about 7700 MS patients, more than half (56%) reported sleep disturbances, including insomnia, which can have negative effects on physical and mental health. These sleep problems often overlap with depression, Dr. Clancy noted. Patients with MS are at 26% to 51% increased risk for depression compared with the general population, she said.

The new study was a retrospective analysis of 11 MS patients who participated in individual or group CBT at the Sleep Disorders Center at the Cleveland Clinic Foundation between January 2008 and December 2013. The 1 male and 10 female participants ranged in age from 36 to 69 years; 8 were white, and 3 were African American.

Researchers assessed depression, fatigue, and insomnia before and after the treatment intervention using the Patient Health Questionnaire (PHQ-9), the Fatigue Severity Scale (FSS), and the Insomnia Severity Index (ISH), respectively. The tests all use self-reported measures.

The CBT, which took place over an average of 4 to 6 sessions, targeted specific behaviors and thoughts related to sleep. Components included the following: stimulus control (going to bed only when sleepy, limiting activities in bed to sleep and sex, getting out of bed at the same time every morning, and arising if not asleep within 20 minutes); sleep hygiene (for example, limiting use of caffeine and other simulants before retiring and having no technology within reach while in bed); relaxation training; and cognitive therapy.

The study showed that patients reported improvements across all domains. A majority (73%) reported an increase in total sleep time ― an overall increase of 1.25 hours.

About 60% of the patients reported a reduction in fatigue (mean change, 1.9), but all patients continued to have a clinical level of fatigue.

"We used a scale for fatigue that just rated a patient as having clinical fatigue or not having clinical fatigue," explained Dr. Clancy. "Everybody reduced their level of fatigue, but they were still clinically fatigued, which is not surprising given that it's MS."

Half of the patients reported improvement in depression measure (mean change, 1.2), and they reported an overall decrease in depression severity. About 86% of the group reported improvement in insomnia, and 43% reported an overall reduction in severity of insomnia.

Root Cause

Asked to comment, Robert Lisak, MD, professor and chair, Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, and new president of the CMSC, said that CBT can be helpful for fatigue in MS patients, but it depends on the root cause of the fatigue.

For example, it will not do much for fatigue caused by "getting up 3 times during the night to go to the bathroom to urinate" because of a bladder problem, but it may be useful if the fatigue is linked to depression, said Dr. Lisak. "You can try to fish out the cause, but it's my experience that it's almost never just 1 factor."

Obesity, which increases risk for obstructive sleep apnea, may contribute to insomnia and fatigue in MS patients, noted Dr. Lisak.

In addition to CBT, doctors may turn to pharmacologic approaches to treat fatigue, including amantadine (Symadine, Solvay Pharmaceuticals, Inc), a drug originally used to prevent flu. Another approach, usually done in collaboration with physiotherapists or occupational therapists, is "economy of effort," said Dr. Lisak. This involves encouraging patients to plan ahead with respect to daily activities ― for example, going upstairs only once to fetch things instead of going up and down 4 times.

Dr. Clancey and Dr. Lisak have reported no relevant financial relationships.

6th Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS). Abstract CG26. Presented May 29, 2014.

Link: http://www.medscape.com/viewarticle/826015

Neuropsychology Neuroplasticity Brain

In Soft-Wired, Dr. Michael Merzenich--a world authority on brain plasticity--explains how the brain rewires itself across the lifespan, and how you can take control of that process to improve your life. In addition to fascinating descriptions of how your brain has produced your unique memories, skills, quirks, and emotions, Soft-Wired offers sound advice for evaluating your brain and gives clear, specific, scientifically proven guidance for how to rejuvenate, remodel, and reshape your brain to improve it at any age.

Contents:Part one: Your brain is a work in progress
Part two: Brain plasticity throughout life
Part three: Creating "you"
Part four: The brain in retreat
Part five: Strengthening, correction, and rejuvenation through brain training







Link: http://www.soft-wired.com/

Meditate

Quotes

"Free yourself from pleasure and pain. For in craving pleasure or in nursing pain there is only sorrow." 
- Buddha

Tweets Quoted

Mind Blowing ‏@MlNDBLOWINGS 1

The world's most fearless creature is the Honey Badger, according to Guinness World Records.

A small amount of alcohol can be found in many popular soft drinks, including Coca-Cola and Pepsi.

The human brain named itself.

If the entire history of the world were scaled down to 14 years, the history of humans would last only 3 minutes.

When you remember a past event, you're actually remembering the last time you remembered it, not the event itself.

Hypnagogia is a state where you start hallucinating between wakefulness and sleep.

Elvis Presley never performed an encore at his concerts - hence the phrase "Elvis has left the building."

Quitting junk food produces changes in the brain similar to withdrawal from addictive drugs.

You have a "second brain" in your gut, called the Entreric nervous system. This is where the term "gut feeling" comes from.

Gelotophobia is the fear of being laughed at.

Wearing skinny jeans can cause nerve damage in your legs, a condition called "tingling thigh syndrome."

Mice were exposed to heavy metal music in an experiment. Instead of finishing the maze, they became aggressive and killed each other.

About 10% of people have a protruding belly button, or an "outie."

The Heart Attack Grill's Quadruple Bypass Burger has 9,983 calories.

Drinking 16 ounces of cold water on an empty stomach will increase your metabolism by 30%.

In 1 hour of reading a book your eyes make nearly 10,000 coordinated movements.

Sesame Street songs were used to torture detainees at Guantanamo Bay.

"Are you as bored as I am?" Read that backwards, and it still makes sense.

The medical term for men suffering from having a huge penis is Oversized Male Genitalia, or OMG.

A group of cockroaches is called an intrusion.

"Limerence" is the technical term for having a crush on someone.

Rumination is being unable to get something off of your mind.

The more you multitask, the more likely you are to feel depressed or anxious.

The ideal amount of money a person in the U.S. should make per year to be happy is $75,000.

The opposite of deja vu is jamais vu - being unfamiliar with something which should be very familiar.

Dopamine actually makes your brain addicted to seeking more and more information via texts, emails, tweets, etc.

Spermology is the study of trivia.

MS Society of Canada - Living with MS - MS Updates

MS Society of Canada - Living with MS - MS Updates: "MS Society supported study investigates relationship between cannabis use and cognitive dysfunction in MS


MS Update
May 23, 2014
 

Background:

Cognitive dysfunction affects 40-60% of individuals with MS. Common signs of cognitive dysfunction include decreased memory, concentration, and attention, as well as difficulty putting thoughts into words. It has been shown through functional magnetic resonance imaging (fMRI) that in individuals with MS, additional regions of the brain are activated while they are performing cognitive tasks. This is presumed to occur as a type of compensation for the structural abnormalities that are present. fMRI works by looking at blood flow in the brain in real time to detect areas of activity. Where there is increased activity, blood flow to that region increases. This technique is unique in that it can observe how the brain functions, compared to standard MRI which can only detect structural abnormalities. 

Cannabis is sometimes used by people with MS as a type of treatment to offer relief from symptoms such as pain, spasticity, and tremor. As a treatment, cannabis can be taken orally or smoked. Recently new research has surfaced evaluating the benefits of smoking cannabis in relieving symptoms. However, some studies have reported cognitive challenges in people with MS who smoke cannabis for medical purposes. An MS Society funded study recently conducted in Toronto used fMRI to investigate how smoked cannabis affects cognition in individuals living with MS.

The Study:

MS Society funded researcher and psychiatrist Dr. Anthony Feinstein and colleagues conducted a study with 39 subjects diagnosed with MS. Twenty of the subjects regularly smoked cannabis (but had not done so in the 12 hours preceding the test), while the other 19 were nonusers. All subjects underwent fMRI while performing three different versions of a working memory test known as N-Back. The researchers compared brain activity between the two groups while the subjects completed the tests. The researchers also collected data on resting-state fMRI, which measures brain activity while the subjects were not completing any tasks. Structural MRI data was gathered to evaluate any differences in brain structure between the two groups. Additional tests were administered to obtain data on measures of verbal and visual memory, information processing speed, and attention.

Results:

The researchers found that individuals with MS who smoked cannabis  performed less well than individuals with MS who did not smoke cannabis on the third version of the N-Back test - known as the 2-Back - which is more difficult than the first two versions. However, while the cannabis group obtained fewer correct answers, their reaction times were the same as the nonusers. In addition, fMRI results showed abnormal patterns of brain activity in the cannabis group. There were no differences found between the two groups in the data collected from the resting-state fMRIs and structural MRIs. The data collected from the other tests showed that the cannabis group performed more poorly on the 2-second Paced Auditory Serial Addition Test (PASAT), which measures information processing speed, and on a visual test.

Comment:

With more people exploring the use of alternative and complementary approaches such as cannabis for treating MS symptoms, it becomes increasingly important to determine the risks of the treatment versus the benefits. This study adds to the growing body of scientific evidence demonstrating the effects of cannabis in people living with MS. It demonstrates that smoking cannabis may add to the cognitive challenges experienced by people with MS, and researchers now have imaging data which could explain this observation. The disorderly pattern of brain activation in the cannabis users may suggest that the brain is compensating, or working much harder, to overcome the tasks required. Results from the study may help to better inform decisions around the prescription and use of medical cannabis, but also pave the way for the development of imaging approaches that can more accurately measure cognitive deficit in people with MS.

Source:

Pavisian B et al. Effects of cannabis on cognition in patients with MS. Neurology 2014 April 30 [Epub ahead of print]

 

National Research and Programs
Disponible en français.

Disclaimer
The Multiple Sclerosis Society of Canada is an independent, voluntary health agency and does not approve, endorse or recommend any specific product or therapy, but provides information to assist individuals in making their own decisions.
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Link: http://mssociety.ca/cgi-bin/MasterPFP.cgi?doc=http://www.mssociety.ca/en/help/msupdates/msupdate_20140523.html

Psychological Coping for Chronic Pain

Chronic pain is one of the most frustrating conditions....

Doctors and other health care professionals are used to thinking about a symptom as something presented by a specific disease process that can be diagnosed by a specific test and treated by a specific treatment.

Chronic pain does not follow those rules.

Often there is no single specific cause to explain chronic pain. Even the most sophisticated tests are often unable to pinpoint a specific cause.

Non-physical factors, often not considered by doctors- including surgeons- such as stress, interpersonal interactions, anxiety, work situations and so forth, play a significant role in the severity and persistence of chronic pain.

Many doctors are recognizing that chronic pain can best be treated by a multidisciplinary group of health care professionals, rather than a single physician.

If you are in chronic pain, consult with a physician who specializes in chronic pain about various treatment options.

Chronic pain is a very difficult problem with which to cope. It is caused by factors such as scarring, nerve irritation and so forth, that cannot be cured.

Do not expect to be “cured” or completely pain free. What you can expect is to be able to cope with and manage the pain at a tolerable level and to be able to have a meaningful life in spite of having some pain.

You probably want to be able to go back to a productive life without strong pain medications that interfere with functioning. This life may look different than your life prior to pain, but you can expect it to still be productive and meaningful.

Effective interventions depend on the motivation, cooperation and efforts of everyone involved – the patient, the patient’s significant other and the support system.

Once pain is being managed, be sure to follow the recommendations of your medical team regarding what to do at home to continue to enjoy reduced levels of pain.

A few simple exercises and relaxation techniques practiced faithfully every day can produce long-lasting results and end the cycle of stress, frustration and pain.


Excerpted and adapted from: 
Medical Factors: Surgical Procedures
Posted on March 1, 2014 by Psychological Health Services, LLC
-Dr. Jeni Heinemann, psychologist

Psychological Coping for Chronic Pain – Medical Factors: Surgical Procedures | psychhealthblog:
Link: /http://psychhealthblog.wordpress.com/2014/03/01/psychological-coping-for-chronic-pain-medical-factors-surgical-procedures/

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Job Search with Chronic Illness

 Any prolonged illness can result in negative thinking and limited perceptions. Sometimes this is caused by the illness itself and sometimes because of the effect the illness has on your lifestyle.any prolonged illness can result in negative thinking and limited perceptions. 

Sometimes this is caused by the illness itself and sometimes because of the effect the illness has on your lifestyle.

Achieving things and being successful in spite of illness can be a big challenge.  M.S. being chronic and progressive makes the picture even darker.  But  sometimes hope and perseverance can bolster our creativity to find self-employment , for instance.  Trying to use your mind for something other than monitoring how you feel, sick or not bad, saves you from sinkin g into a deep depression.  We all need distractions from the self-centered attitude that can become a feature of chronic illness.


Guide to Job Search with Chronic Illness,

A job search can be a very challenging life experience, and, if you also have a chronic illness, that challenging experience can become even more daunting - like climbing a mountain with a 150 pound pack on your back.

However, like most of life's challenges, people with the right tools, information, and motivation can succeed in spite of the difficulties they encounter."



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Link:  Job Search with Chronic Illness - Job-Hunt.org:

Link: http://www.job-hunt.org/chronic-illness-job-search/chronic-illness-job-search.shtml

Chronically Happy: Joyful Living in Spite of Chronic Illness - Lori Hartwell - Google Buku

Chronically Happy: Joyful Living in Spite of Chronic Illness - Lori Hartwell - Google Buku:



"Chronically Happy: Joyful Living in Spite of Chronic Illness


Lori Hartwell
Poetic Media, Incorporated, 2002 - 250 halaman
2 Resensi

When Doctors Put Two-Year-Old Lori Hartwell on dialysis after her kidneys mysteriously stopped working, they didn't expect her to live. That was the first time she beat seemingly insurmountable odds to survive, and she continues to one-up the statistics today. In Chronically Happy, Hartwell shares her remarkable story and introduces the principles she's relied on to thrive while living with a chronic disease. Hartwell's wisdom covers a range of subjects, from dating and working to building self-esteem and deepening relationships. Through anecdotes and workbook-style exercises, Chronically Happy helps people with illness. If you have a chronic illness, Chronically Happy is the tool you need to shape the life you've always envisioned but never thought possible. Book jacket.
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