Anna Kratz, PhD, on Managing MS Fatigue in a Multifaceted Way

Anna Kratz, PhD

This is the second of a 2-part conversation. For part 1, click here.

The care of patients with multiple sclerosis (MS) is often taken on by a comprehensive care team, which aims to help address the patient as a whole rather than symptomatically manage their disease one facet at a time. This team model has become the ideal standard for care, and while many community neurology practices might lack the resources to fulfill each part of that model, the field has shifted in this direction.

This model helps not only in providing a more patient-focused care paradigm, but in offering variety for individuals. One such area that benefits is the treatment of fatigue, which has been shown to place a heavy burden on patients with MS.Anna Kratz, PhD, associate professor of Physical Medicine & Rehabilitation, and a research nonclinical psychologist, University of Michigan Medicine, provided an overview of some of the ways the care team can approach treating fatigue at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), October 25-28.

In a conversation with NeurologyLive, she provided additional context to that presentation and shared the number of ways that fatigue in MS should be assessed and addressed.

NeurologyLive: What role does cognitive behavioral therapy play in this care process?

Anna Kratz, PhD: Cognitive behavioral therapy (or CBT) and acceptance and commitment therapy are 2 of the therapies that I covered in the session that have evidence for being beneficial for fatigue, both in the short- and long-term. There is evidence for it, especially in neurology, though people might not think of psychology as being helpful for fatigue. I've been at tables where people just automatically refer to me as a neuropsychologist—now, neuropsychologists play an important role in MS care, in assessing and tracking cognitive changes and helping people manage cognitive changes. And sometimes a neuropsychologist can help with things like managing symptoms—but I'm not a neuro psychologist, I'm a health psychologist and a clinical psychologist who uses interventions like cognitive behavioral therapy and acceptance and commitment therapy to help manage symptoms. That's really surprising, even to MS clinicians, that that is available. In the psychology field, we're well aware of CBT and act to help manage symptoms, but I think outside of psychology, it might not be as well known.

What do you want clinicians to understand about how they may potentially be able to manage fatigue issues?

Well, I think maybe the main takeaway from the presentation today is just the importance of considering all the options that are available to a given patient. There's a lot of talk about precision health and tailored interventions, and that's really at the heart of the presentation today is trying to find what works for whom. That's question number 1.

Then, question number 2 is: what are all the different things that might work for a person, and how might those things change? Because we often hear that what worked for you last month is now not working. What do you need to tweak? Taking a multidisciplinary approach allows you to tweak across a bunch of different domains, potentially, instead. If somebody is only on a medication, for instance, your options for tweaking their care over time are really limited. It's really about making care more patient-centered, more tailored to every person at a given time.

What are the themes or theme that you've taken away from CMSC 2021 and your experience overall?

Well, it's kind of interesting even just being back at CMSC, after having been gone for so long. Besides kind of the new topics of like, “What's going on with COVID?” and the usual topics of what's new with disease-modifying therapies and other symptom management kinds of therapies, there are new innovations and new kinds of therapies, which I find very interesting.

I always get really more drawn towards the more behavioral intervention talks—they're more in my wheelhouse—even though I do try to keep a handle on some of the new stuff that's happening in medicine. There's a cannabis talk here as well. It's interesting to just see what's new in those areas.

But this is also the place where you can find the latest tried-and-true information about interventions across all kinds of issues for MS. I thought it was really neat—that we're talking a lot about like women women's issues, specifically in MS, at this conference, and diversity and equity inclusion issues. A lot of it is it seems like what's happening in society is sort of reflected here, too. That there's a new focus on diversity, minority issues in MS, so that was neat to see too.

Transcript edited for clarity. For more coverage of CMSC 2021, click here.

REFERENCE
Kratz A. Combined Approaches to Fatigue in MS. Presented at: CMSC 2021; October 25-28; REHAB1.