Chronic pain in multiple sclerosis: A10-year longitudinal study

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_j.sjpain.2017.04.070_s_007_w2aab3b7d278b1b6b1aab1c15b1Aa"><jats:title>Background and purpose</jats:title><jats:p>Pain is a common symptom associated with multiple sclerosis (MS), and has lasting effects on an individual’s functional capacity and quality of life. A wide range of prevalence rates of pain (between 23% and 90%)have been reported in MS and this is mainly due to the methodological differences amongst the studies such as variability in patient sources, method of sampling and the definition of pain used. Chronic pain in MS, defined as pain lasting for greater than 3–6 months, can have a significant impact on their biopsychosocial health, including negative impact on activities of daily living, relationships and social participation. The long-term course of MS-related pain and its impact in an Australian cohort over a 7-year period has been investigated earlier. The aim of this longitudinal study was to describe the impact of chronic pain, pain-related disability and carer burden in persons with MS over a 10-year period. The aim of this longitudinal study was to describe the impact of chronic pain, pain-related disability and carer burden in persons with MS over a 10-year period.</jats:p></jats:sec><jats:sec id="j_j.sjpain.2017.04.070_s_008_w2aab3b7d278b1b6b1aab1c15b2Aa"><jats:title>Methods</jats:title><jats:p>This was a prospective longitudinal study conducted at the Rehabilitation Department of Royal Melbourne Hospital (RMH), a tertiary referral hospital in Victoria and Australia. The source of participants was from the RMH MS database and contains detailed MS patient information including demographic data, diagnosis details (using McDonald’s criteria), pain characteristics. Structured face-face interviews and validated measures were used, which include the visual analogue scale (VAS); chronic pain grade (CPG); the assessment of quality of life (AQoL) and the carer strain index (CSI). The mean age of the participants (<jats:italic>n</jats:italic> = 70) was 55.3 years and majority (70%) were female.</jats:p></jats:sec><jats:sec id="j_j.sjpain.2017.04.070_s_009_w2aab3b7d278b1b6b1aab1c15b3Aa"><jats:title>Results</jats:title><jats:p>The mean age of the participants (<jats:italic>n</jats:italic> = 70) was 55.3 years and majority (70%) were female. The findings show that over time (10 years), participants report having greater bilateral bodily pain and greater description of pain as ‘worse as it could be’. Pain types were similar to 7-years follow-up but remained higher than baseline. There was a significant deterioration in quality of life in those with more severe CPG over time. Almost half of the participants 31 (44%) required care either from a private carer, institution or from a family member. Although fear of taking medications and side effects were common barriers to treatment for pain, there was an increase in the use of pharmacological treatment over time and an increase in the use of healthcare services, mainly neurologists and general practitioners.</jats:p></jats:sec><jats:sec id="j_j.sjpain.2017.04.070_s_010_w2aab3b7d278b1b6b1aab1c15b4Aa"><jats:title>Conclusions</jats:title><jats:p>The pain measures reported by the participants were similar to those at the 7-year follow-up except there was a greater representation of bilateral pain locations (limb, trunk and facial pain) compared to baseline and 7-year follow-up. At 10-year follow-up, more participants used medications compared tc 7-year follow-up and there was an increase in the use of health professionals at the 10-year follow-up At the 10-year follow up QoL of the participants deteriorated significantly and more participants had progressed to higher CPGIII and CPGIV. This study demonstrates that chronic pain is a significant issue over time in MS, with clinical and health implications, impact on quality of life, disability and healthcare utilization.</jats:p></jats:sec><jats:sec id="j_j.sjpain.2017.04.070_s_011_w2aab3b7d278b1b6b1aab1c15b5Aa"><jats:title>Implications</jats:title><jats:p>Greater awareness of chronic pain in pwMS, cognitive classifications and an interdisciplinary approach is required to improve long-term patient outcomes and well-being.</jats:p><jats:p>Crown Copyright © 2017 Published by Elsevier B.V. on behalf of Scandinavian Association for the Study of Pain. All rights reserved.</jats:p></jats:sec>

The association between multiple sclerosis and pain medications

“…121 . Experiences of pain also reduce the capacity for economic activity in MS patients, particularly if the work is physically demanding, and can be a leading cause of disability among this patient group 122 . The consequences of these experiences of MS symptoms on adult patients can ultimately reduce economic activity, which can impact on income, and other resources.…”

Prodromal symptoms of multiple sclerosis in primary care

“…Notably, pain is among the most prevalent and disabling symptoms in MS. Multiple sites in the body can be affected, and this variety likely reflects the multiple mechanisms potentially leading to pain in this disease, including neuropathic and/or nociceptive origins (eg, spasticity, joint, and muscle pain) . The increased occurrence of pain before clinically overt disease highlights the potential relevance of damage within specific pain networks in the central nervous system.…”

Cognitive Behavioral Therapy for the Management of Multiple Sclerosis–Related Pain

“…More than half of all people with MS endorse having pain, which can affect their daily functioning, emotional well-being, and quality of life. 2,[5][6][7][8][9] Although pharmacologic treatments are most often used, 3,8 they do not target the cognitive, behavioral, and psychosocial factors that may be contributing to the pain experience. 6 The present study investigated whether CBT, an effective intervention in the general chronic pain population, 14 could be beneficial for MS-related pain.…”

“…3,5,6 In a longitudinal study of chronic pain in persons with MS, a significant deterioration in quality of life was noted at 10-year follow-up. 7 Although MS alone can result in functional difficulties, the presence of pain can contribute to further impairment, such as interference with employment and engagement in recreational activities. 5,8 Psychological well-being can CBT for MS Pain (EHRs) to confirm that 1) reported pain was directly related (eg, pain associated with optic neuritis) or indirectly related (eg, pain due to muscle contractions) to MS 19 ; 2) documentation of "optimal pharmacologic management" of MS-related pain was present; and 3) appropriate pharmaceutical interventions were currently being used.…”