Oral antipyretics for fatigue alleviation and exercise enhancement in adults with multiple sclerosis: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: p = 0.013 for time to exhaustion

• Effect Size: Significant improvement with aspirin pretreatment

• Primary Outcome: Time to exhaustion in heat-sensitive MS patients

• Nnt Or Sensitivity: 56% reduction in post-exercise temperature rise (statistical significance varied between studies)

• Confidence Interval: Not reported

Clinical Application

High feasibility as aspirin and acetaminophen are readily available over-the-counter medications Both aspirin and acetaminophen are PBS-listed and readily available. Would require consideration of TGA safety warnings for aspirin use, particularly bleeding risks. RACGP guidelines would need updating if evidence becomes more robust. Adults with multiple sclerosis experiencing heat sensitivity and exercise intolerance

Abstract

AIMS: This review aims to explore the potential role of oral antipyretics (aspirin (ASA)/ acetaminophen), commonly known for fever and pain control, in managing fatigue, temperature regulation, and exercise capacity in patients with Multiple Sclerosis (MS), with a focus on nursing implications for symptom management. DESIGN: A systematic review of existing clinical studies assessing the effects of aspirin/ acetaminophen on MS-related fatigue, thermoregulation, and exercise performance. DATA SOURCES: Electronic databases including Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PubMed, Scopus, Web of Science, Wiley, Google Scholar, and ClinicalTrials.gov were searched up to March 2024. REVIEW METHODS: Quality assessment was conducted using the Cochrane risk of bias tool 2. to evaluate the methodological rigor of included studies. Outcomes analyzed included clinically assessed fatigue scores, exercise endurance, and post-exercise thermoregulation, with attention to potential risks associated with aspirin use. RESULTS: After assessment of 57 reports for eligibility, only seven studies met inclusion criteria; results indicated that aspirin pretreatment significantly improved Time to Exhaustion (TTE) in heat-sensitive MS patients (p = 0.013), though one study reported no significant effect. Aspirin reduced post-exercise temperature rise by 56%, but this was not statistically significant in one trial (p = 0.178), while another showed significant reductions (p = 0.002). CONCLUSION: Aspirin and acetaminophen may offer benefits in alleviating fatigue, enhancing thermoregulation, and improving exercise endurance in MS patients. These findings suggest that nurses should consider the potential role of aspirin in symptom management, with further research needed to confirm efficacy and safety. IMPACT: This review highlights a potential adjunct therapy for nurses to incorporate into comprehensive MS care, emphasizing symptom control and quality of life improvements. PATIENT OR PUBLIC CONTRIBUTION: Not applicable. TRIAL REGISTRATION: This review is PROSPERO registered having ID CRD420251000875.

References

1. 1.Ibrahim, I. A., Hamdy, A. M., Shehata, M. M., Elewa, M., Elmandrawi, S. W., Elemam, A. M. E., Ibrahim, S., Abohalawa, M. N., & Raza, M. L. (2026). Oral antipyretics for fatigue alleviation and exercise enhancement in adults with multiple sclerosis: a systematic review and meta-analysis. Neurological Sciences. https://doi.org/10.1177/135245850000600307