Chronic pain in multiple sclerosis: Is there also fibromyalgia? An observational study

Abstract

BackgroundChronic pain is common in persons with multiple sclerosis (MS), but the co-morbidity of fibromyalgia (FM) has yet to be investigated in MS. Objectives of the study were to evaluate, among the various types of chronic pain, the frequency of FM in MS and its impact on MS patients’ health-related quality of life (HRQoL).Material/Methods133 MS patients were investigated for the presence and characterization of chronic pain within 1 month of assessment. A rheumatologist assessed the presence FM according to the 1990 ACR diagnostic criteria. Depression, fatigue, and HRQoL were also assessed by means of specific scales.ResultsChronic pain was present in 66.2% of patients (musculoskeletal in 86.3%; neuropathic in 13.7%; absent in 33.8% [called NoP]). Pain was diagnosed with FM (PFM+) in 17.3% of our MS patients, while 48.9% of them had chronic pain not FM type (PFM−); the prevalence of neuropathic pain in these 2 sub-groups was the same. PFM+ patients were prevalently females and had a higher EDSS than NoP. The PFM+ patients had a more pronounced depression than in the NoP group, and scored the worst in both physical and mental QoL.ConclusionsIn our sample of MS patients we found a high prevalence of chronic pain, with those patients displaying a higher disability and a more severe depression. Moreover, FM frequency, significantly higher than that observed in the general population, was detected among the MS patients with chronic pain. FM occurrence was associated with a stronger impact on patients’ QoL.

Chronic Pain in Multiple Sclerosis Patients: Utility of Sensory Quantitative Testing in Patients with Fibromyalgia Comorbidity

“…Our group recently highlighted the high prevalence of FM comorbidity in advanced MS [10]. In our MS series a 17% of the patients enrolled was diagnosed with FM according to the 1990 ACR criteria.…”

“…All the patients were selected from a total of 205 in- and out-patients undergoing rehabilitation for MS at the Santa Lucia Foundation, a large free-standing university-affiliated rehabilitation institute not dependent on an acute-care general hospital [10]. The exclusion criteria were age <18 years, other known neurological or rheumatic diseases, other disorders of the spine, cancer, renal diseases, diabetes mellitus, severe psychiatric diseases, relapses within one month prior to enrollment, and a Mini-Mental State Examination score <23 [15].…”

“…Previous studies reported a prevalence range of 5-15%, based on self-reported validated questionnaire and administrative claim records [8,9]. More recently, as assessed by a ward rheumatologic examination, a 17% prevalence of FM comorbidity has been reported in the latest stage of MS, and resulting similar to those reported in rheumatic diseases like SLE and RA [10]. FM has been recently reconsidered in its pathophysiology.…”