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Gray Matters: Treating Multiple Sclerosis and How it Treats You

Explore how you'll treat MS, including DMTs, diet and nutrition, and mind-body techniques.

A woman sits with her legs crossed and her hands resting on her knees in a meditation pose.

Key Points

Disease-modifying therapies are considered the cornerstone of MS treatment, working to suppress or modify the activity of the immune system.
Some of the more common alternative therapies include acupuncture, cannabis-based products, diet and nutrition, and mind-body techniques—like yoga, meditation and tai chi.
The annual economic burden that MS places on the United States is upwards of $85.4 billion, according to the National MS Society.

Over the past week, I've awakened with a headache for three consecutive days—a dull pain in the front of my head that makes it feel heavy and impossible to lift off the pillow.

My thoughts immediately go to my current MS disease-modifying therapy (DMT). Headaches are one of the common side effects of teriflunomide. It's part of my multiple sclerosis treatment plan.

Living with multiple sclerosis

When I started taking the medication to treat multiple sclerosis a few months ago, I took it in the morning and developed headaches. I switched to taking it at night in an attempt to sleep through the side effects, and that worked for a while, but now, perhaps the headache was outlasting my slumber.

Would the headaches get worse? Would they get so bad that I would need to change medications again?

My first prescribed medication, dimethyl fumarate, listed flushing as a side effect. At first, the flushing was minor. No big deal.

But it gradually got worse, to the point where it was visible to colleagues sitting on the other side of a conference table. The mottling on my skin merged into what looked and felt like sunburn.

The best-known tactic to mitigate the flushing—taking a low-dose aspirin 30 minutes before taking the medication—did not work. So, my neurologist and I decided a switch was necessary.

Treatment for multiple sclerosis

Two types of medication are used to treat multiple sclerosis: DMTs, and the wide variety of drugs that control secondary symptoms.

These medications can improve quality of life by slowing the progression of multiple sclerosis, reducing the number of relapses and mitigating bothersome and potentially embarrassing symptoms that can impact relationships and every other aspect of life.

It's hard to feel sexy or even want a date night when you’re battling fatigue and muscle pain and worrying about peeing yourself in public or during an intimate moment.

Sexual dysfunction was one of the most common complaints of people with multiple sclerosis, indicated a 2021 study.

"It’s not uncommon for my patients to experience changes in their sexual health due to anxiety caused by MS,” said Joey Gee, DO, a neurologist at Providence Mission Hospital. “I encourage my patients to be open with their partners as they navigate their MS journey.”

Disease-modifying therapies

Disease-modifying therapies are considered the cornerstone of MS treatment. DMTs work to suppress or modify the activity of the immune system.

They can reduce the number and severity of MS attacks, slow down the accumulation of disability over time and decrease the formation of new lesions in the brain.

There are several types of DMTs available, including injectable medications like interferon beta and glatiramer acetate, oral medications like dimethyl fumarate, teriflunomide and fingolimod, and infusion therapies. Each type works differently and has its own benefits and potential side effects.

The choice of DMT depends on factors such as the type of MS, the individual's medical history and personal preferences.

While DMTs effectively manage MS, they may also have potential side effects. Common side effects include flu-like symptoms, injection site reactions, gastrointestinal issues and liver function abnormalities.

Some DMTs carry specific risks, such as increased infection susceptibility or potential cardiac side effects.

Symptom-specific medications

In addition to DMTs, medications are available to manage specific MS symptoms and improve daily functioning. These may include medications for:

Bowel dysfunction
Cognitive function
Depression
Dizziness & Vertigo
Emotional changes
Fatigue
Infection
Itching
Muscle spasms
Pain
Tremors
Urinary incontinence
Walking difficulties

Alternative treatments

After a multiple sclerosis diagnosis, patients sometimes seek alternative treatments to manage their symptoms and improve their quality of life.

“Therapies like yoga can help reduce stress and improve balance and mobility, which are important concerns for people with MS,” said Tamika Haynes-Robinson, Ph.D., a neuropsychologist at Orlando Health.

Some of the more common alternative therapies include:

Acupuncture can relieve pain, fatigue and spasticity.
Cannabis-based products can manage symptoms like pain and spasticity.
Diet and nutrition can help manage symptoms.
Mind-body techniques—like yoga, meditation and tai chi—can improve symptoms like fatigue, anxiety and depression, and improve overall well-being.

“There's been recent research suggesting that intermittent fasting and reducing your intake of inflammatory foods can help to mitigate some MS symptoms and reduce the number of flare-ups you have,” Haynes-Robinson said.

“Lowering your sugar intake in all forms, not just from pastry and candy, but things like flour, wheat products, potatoes, pasta and rice, and managing your salt intake, is also important—especially for someone with weight issues. Extra weight can impede your mobility.”

Anti-inflammatory diet

The use of an anti-inflammatory diet is a topic of interest for individuals with multiple sclerosis who want to manage their symptoms and potentially reduce inflammation. There is ongoing research in this area that encourages that decision.

Some specific components of an anti-inflammatory diet, such as omega-3 fatty acids found in fatty fish, like salmon and mackerel, and plant-based sources, like flaxseeds and walnuts, have been studied for their potential benefits for multiple sclerosis. Omega-3 fatty acids have been associated with reduced inflammation and improved neurological function in animal models.

A diet that's often recommended by nutritionists is the Mediterranean diet, which emphasizes fruits, vegetables, whole grains, legumes, fish and healthy fats while limiting red meat, processed foods and sugary beverages.

The Mediterranean diet is known for its anti-inflammatory properties and various health benefits.

Some studies suggest that adherence to a Mediterranean diet may have a positive impact on MS-related outcomes, such as improved quality of life and reduced disability progression.

More generally speaking, adopting a healthy, balanced diet is usually recommended for overall well-being.

It's important to consult with your healthcare provider to discuss alternative treatments, their potential benefits and any interactions or risks associated with conventional MS treatments.

The cost of MS

Like most chronic progressive conditions, treating MS comes with a heavy price tag. The annual economic burden that MS places on the United States is upwards of $85.4 billion, according to the National MS Society.

That number is broken down as follows:

$63.3 billion: Direct medical costs, including DMTs, other medications, hospital and office visits and medical equipment.
$21 billion: Indirect costs such as missed work and early retirement.
$1.1 billion: Non-medical caregiving costs, home and vehicle modifications and similar ancillary services.

Treatment costs for multiple sclerosis can vary significantly based on factors like insurance coverage and the medications prescribed.

DMTs are some of the costliest medications by disease category, with prices rapidly increasing over the last few decades, indicated a 2021 report published in the National Library of Medicine.

The study reports that DMTs are responsible for the majority of the pharmaceutical and total healthcare spending for MS.

It also states that many DMTs cost more than $90,000 per patient annually, causing a financial burden for the healthcare system and barriers for patients due to unaffordable out-of-pocket costs and restrictions by health insurance providers.

Financial assistance programs and patient support services may mitigate the burden for some. Generic options can also reduce costs.

Online resources for MS

Many trusted websites are providing authoritative and useful information about multiple sclerosis. Here are four links to get you started on your journey: