<p>It is important for health care providers to be aware of any stressful psychosocial factors in the lives of their patients with multiple sclerosis (MS) so that they can understand the patients’ symptoms more fully and treat them appropriately. Neurologists should inquire about and address these situational issues during regular visits and should work with other health care team members as appropriate to manage comorbidities.</p>

One of the benefits of caring for patients with MS is developing a partnership where you understand certain situations in their personal lives, including their living situation, interests, family, work, stressors, struggles, and support system. Having an ongoing awareness of these issues is very important for understanding a patient’s symptoms and treating them appropriately. Inquiries about a patient’s mood should be made during every visit because both depression and anxiety can be big issues in patients with MS. Additionally, difficulty sleeping, increased fatigue, and changes in cognition and mood are all core symptoms of MS that we try to address both pharmacologically and nonpharmacologically during patient visits.

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Coming up with ways to help patients address issues without the use of additional medications is always good, whether it is incorporating, for example, rehabilitation services for a home exercise program, Kegel exercises for bladder issues, or behavioral interventions for addressing symptoms. It is also critical that patients with MS continue to be seen by other members of their health care team, such as their primary care physician, gynecology, dermatology, and cardiology, among others, to make sure that they are doing well and are receiving routine health screenings and counseling. It is important that the full health care team is involved, especially with the medications that the patient is using.

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We need to inquire about what is going on in our patients’ lives because patients may not make the connection between stressful situational issues and worsening MS symptoms. When inquiring about these types of issues during our routine visits, we begin to understand how symptoms are related to stressors and life events all the time. This is why it is important to understand a patient’s living situation, who provides their support, who they help, and who they rely on because having problems at work or with family members is often going to manifest as a worsening of symptoms or new symptoms. And then we have to determine whether the patient is experiencing a relapse or a pseudorelapse. We definitely have to get into those situational issues to understand where a patient is coming from.

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Depending on what resources are available, MS team management can include, for example, rehabilitation services that encompass physical, occupational, speech, cognition, and vision services, as well as mental health counseling, psychiatry referral, and medication prescribing, if warranted. The management of family-related issues may call for recommendations or referrals for family members to see other health care team members, depending on what is going on. A social worker may be helpful, as they can, for example, make phone calls and/or home visits or suggest a medical intervention.