Advanced Symptom Management in Multiple Sclerosis.

Meaningful symptom management can have a profound impact on quality of life. It can challenge time parameters during clinic, and therefore thought should be given to strategies that can improve efficiency and thereby make the undertaking more tenable. For any given symptom, the building blocks of care, such as vitamin D status, exercise/physical therapy, nutrition, and stress management, and ensuring disease-modifying therapy coverage, should be maximized. For each symptom, there are pharmacologic and nonpharmacologic interventions. Patient expectations should be queried early in the encounter so that time can be budgeted accordingly.