Multiple Sclerosis Pathway - Provider Information: MS Symptom Management

People with MS are faced with various symptoms and disabilities that may arise unpredictably and suddenly. While the consulting neurologist should be kept informed of changes in symptoms, the management of symptoms is generally done by primary care practitioners.

Common symptoms experienced by MS patients are as follows. Treatment for MS symptoms may include medication, rehabilitation, and self-management techniques. Primary care providers should treat symptoms in line with recommendations for neurological disease where guidelines are available.

The MS Care Pathway also provides links to patient education resources at…

	Action	Referral	Resources
BLADDER	Discuss self-care Rule out infection Provide patient education and/or resources Consider medication options	Urologists Pelvic floor physiotherapists MS Nurse	Patient Resources MS Canada: Bladder Dysfunction National MS Society: Bladder Dysfunction Other: My bladder management action plan Provider Resources Urinary incontinence in neurological disease NICE clinical guideline 148
BOWEL	Discuss self-care (exercise, healthy diet/bowel habits) Consider other causes Recommend suppositories, consider medication options Provide patient education and/or resources	Dietitians Gastroenterologists Physiotherapists MS Nurse	Patient Resources MS Canada: Bowel Dysfunction National MS Society: Bowel Dysfunction Provider Resources Faecal incontinence in adults NICE clinical guideline 49; (Section 1.7.9 deals specifically with neurological disease or spinal disease/injury)
COGNITION	Screen for concerns Investigate and manage other causes (mood disorders, poor sleep, fatigue) Discuss self-care (exercise, mental activity, awareness and compensatory strategies) Provide patient education and/or resources	Occupational therapists Psychologists MS Nurse	Patient Resources MS Canada: Cognitive Impairment National MS Society: Cognitive Dysfunction Other: Managing Cognitive Problems in MS (patient/provider overview) Provider Resources Recommendations for cognitive screening and management in MS (research paper) MS Journal MSBEST Modules
FATIGUE	Investigate and manage other causes (depression, hypothyroidism, anemia, drug effects) Discuss self-care (exercise, planning, and pacing strategies) Provide patient education and/or resources	Occupational therapists Physical therapists Physiatrists MS Nurse	Patient Resources MS Canada: Fatigue National MS Society: Fatigue Provider Resources The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue
MOOD	Investigate and manage contributing factors Consider medication options Connect to community resources/peer support Discuss self-care (exercise)	Psychologists Psychiatrists Social workers MS Nurse	Patient Resources MS Canada: Depression; Inappropriate Affect National MS Society: Mood Changes Other: Online therapy unit Mental health and addiction services (MHMAS) Saskatoon centralized intake Counselling Connect Sask Call 811 HealthLine Provider Resources Assessment and management of psychiatric disorders in individuals with MS (AAN guideline) Mood changes (clinical bulletins for professionals) MS Society Depression in adults with chronic physical health problems NICE clinical guideline 91
PAIN	Investigate and manage contributing factors and other causes Consider medications and health behaviours Connect to community resources	Psychologists Psychiatrists Physiatrists Pain specialists Exercise therapists Massage therapists Physical therapists Occupational therapists MS Nurse	Patient Resources MS Canada: Pain National MS Society: Sensory Symptoms and Pain Other: Chronic pain management lecture series Alberta Health Services Provider Resources Pain in Multiple Sclerosis (clinical bulletin) MS Society USA
SEXUAL HEALTH	Screen for sexual health concerns Investigate contributing factors and other causes Consider medication options	Psychologists Physiatrists Sexual health specialists Urologists / gynecologists MS Nurse	Patient Resources MS Canada: Sexual Dysfunction National MS Society: Sexual Dysfunction Problems Provider Resources Assessment and Treatment of Sexual Dysfunction in Multiple Sclerosis (clinical bulletin) MS Society USA
SLEEP	Rule out sleep apnea, or treat sleep apnea (CPAP) Consider cognitive behavioral therapy, consider medications short term Discuss self-care (sleep hygiene, manage nocturia)	Respirologist Sleep specialists MS Nurse	Patient Resources Sleepwell: Sleep resources for patients National MS Society: Sleep
SPASTICITY	Rule out or treat conditions that can worsen spasticity (e.g. pain, urinary tract infections) Consider medication options Refer for special procedures (e.g. Botox) Discuss self-care (stretching)	Physiotherapists Physiatrists Occupational therapists MS Nurse	Patient Resources MS Canada: Spasticity National MS Society: Spasticity
WEAKNESS	Discuss physical activity guidelines, individualize recommendations if needed Refer to therapists for assistive devices and safety equipment (cane, walker, sask poles, lifts, etc.) Refer to physiatrist for assistive devices (bracing, power mobility)	Physiotherapists Physiatrists Occupational therapists MS Nurse	Patient Resources MS Canada: Weakness Provider Resources Exercise and Physical Activity (patient/provider overview) MS Society Canada Canadian Physical Activity Guidelines for Adults with MS (patient/provider resource) Canadian Society for Exercise Physiology and MS Society Canada Free from falls comprehensive education and activity program for building balance and avoiding falls (patient/provider resource) MS Society USA