Pain Is Prevalent Across Multiple Sclerosis Subtypes, Study Finds

Pain was almost omnipresent in measured subtypes of multiple sclerosis (MS), where over one-third of participants with relapsing-remitting multiple sclerosis and primary-progressive multiple sclerosis noted pronounced pain, according to Multiple Sclerosis Journal- Experimental, Translational and Clinical.

Differences in pain across subtypes of multiple sclerosis weren’t previously well studied.

Researchers aimed to compare the prevalence of pain, and the link between pain and: (a) pain interference and (b) social participation in people with relapsing-remitting MS (RRMS) and primary progressive MS (PPMS).

Pain can be chronic, serious, and widespread in patients with MS. It is associated with fatigue, decreased health-related quality of life, and poor mental health—no matter the type of MS—and may negatively impact work, general activity, socialization, and other roles.

First, participants in the study filled out the McGill Pain Questionnaire Short-Form-2, Pain Effects Scale (PES) and Ability to Participate in Social Roles and Activities-V2.0 (PROMIS-APS) questionnaires. The association between MS subtype, severity of pain, and pain interference/social participation using quartile regression was tested.

Out of n = 231 participants (RRMS, n = 161; PPMS, n = 70), 82.3% were women. The prevalence of pain was 95.2%, those stating more than mild pain was 38.1%, and pain related limitations was recorded as 87%. There were no differences among subtypes of multiple sclerosis.

Participants with progressive multiple sclerosis reported more pain interference compared to participants with RRMS (mean [SD] PES, PPMS: 15[6.0] vs PPMS: 13[5]; P = .039) and lower social participation (PROMIS-APS T-scores, 45[9.0] vs 48.3[8.9], respectively; P = .011). But, on multivariable analysis accounting for age, physical disability, mood/anxiety and fatigue, multiple sclerosis subtype was not associated with changes in pain interference or social participation.

Of note, pain intensity was not associated with social participation after researchers accounted for symptoms of fatigue, depression, and anxiety. These 3 symptoms are strongly linked with each other among people with MS, even upon diagnosis, and they participate in bi-directional, dynamic relationships with each other. This collection of symptoms is also collectively linked with work impairment.

Higher pain intensity was linked with more pain interference as measured by the PES.

Some differing findings were discovered when researchers analyzed social participation that identified limitations in work and leisure activities, social activities, and fun, but the pain or reasons why these differences were revealed was not specified.

Subtype of MS was not linked with pain interference or social participation after adjusting for age and physical function. More pain intensity was associated with lower social participation, even after adjustment for age and physical function, but not after adjustments were also made for fatigue, depression, and anxiety.

The symptom cluster of fatigue, depression, and anxiety might be more significant drivers of social activity limitations than pain, essentially.

“This highlights the importance of conceptualizing, evaluating and effectively treating pain from a biopsychosocial perspective, which accounts for the complex interrelationships between the highly prevalent and disruptive symptoms of pain, mood, and fatigue in people with MS,” said the study authors.

Limitations in this study consisted of a sample of predominantly women with some post-secondary education at the least, so findings might not generalize to other demographic subgroups. Because of the high data collection burden on participants, pain characteristics were identified only at 1 study visit and researchers did not identify information about pain management.

“Further studies are needed to evaluate the effectiveness of pain management on improving participation in important social domains,” concluded the researchers.

Reference

Jain D, Bernstein CN, Graff LA, et al. Pain and participation in social activities in people with relapsing remitting and progressive multiple sclerosis. Mult Scler J Exp Transl Clin. Published online July 19, 2023. doi:10.1177/20552173231188469