Fatigue in multiple sclerosis: can we measure it and can we treat it? 2024 DeLuca et al

Abstract

Fatigue is a common and debilitating symptom in multiple sclerosis (MS). However, after over 100 years of inquiry its definition, measurement and understanding remains elusive. This paper describes the challenges clinicians and researchers face when assessing and treating MS patients, as well as our understanding of neural mechanisms involved in fatigue. Challenges for the future are discussed.

Open access, https://link.springer.com/article/10.1007/s00415-024-12524-9

 

The hell are they talking about here? It's plenty well-defined, enough to be useful, the problem is that it can't be measured and everything in health care breaks down when faced with the subjective experience of illness, which is a far larger and fundamental problem. At its core the problem is that medicine doesn't trust patient input and is infinitely willing to distort it with bias, but it's all they have, so they locked themselves in a bind, entirely on purpose.

Not dozens, several, but not dozens. However there are dozens of BS psychosomatic concepts, and somehow that multiplicity is not a problem here. Funny how that works.

The standard biopsychosocial approach has been to simply make stuff up and pretend that bad evidence that doesn't support traditional conclusions somehow does. Predictably it hasn't worked, but an entire parasitic industry has been created pretending otherwise, and that has locked everything in a permanent state of failure. This plays a huge role in the total lack of progress on medicine's approach to symptoms that don't directly relate to a simple biological measurement, which is most of them. Delusional garbage like this has infected the whole profession:

The idea that dispassionate scientists are able to understand subjective experience completely removed from theirs was always flawed. But nothing has blocked progress here more than psychosomatic ideology and its various bizarre beliefs and myths, which are heavily reflected here yet again. The profession seems incapable of finding the motivation to move away from a failed model, would rather fanatically keep on trying it while pretending that the fake results they get have any value.

The simple truth is that medicine hasn't just made zero progress at understanding illness without a simple direct relationship to an isolated disease process, it has effectively regressed at it, after decades of miserable failure. The problem isn't just with us, it's just that with us, there is nothing else, so everything is worse off for it.

 

I hear about other conditions that have systemic treatments for the actual condition eg rheumatoid or psoriatic arthritis where there is a good match of that with patient then the ‘fatigue’ (and they’ll say ‘feel ill and awful’) goes away with that.

I thought there were good treatment options starting for MS ? But can’t help being cynical certain conditions are being chosen and not eg the ones in first para to try and blah this idea that fatigue as BPS try and define it isn’t actually’illness’. And that without either treating it properly as an illness or adjustments to mean people are below threshold are your options.

this nonsense of selling gaslighting and bullying the ill to perform and not look so ill and shut up about it is what I smell from all this. With methods of coercion and social pressure to fudge results.

 

To borrow a very applicable quote: the bastards just don't want to do better.

Bastards aside, this is actually true, unlike the original quote. They could do better, they just choose not to, because they don't think they can do better, and their perception is distorted by abnormal beliefs about illness and an irrational fear of failure.