Ecological Momentary Assessment of Pain, Fatigue, Depressive, and Cognitive Symptoms Reveals Significant Daily Variability in Multiple Sclerosis

Abstract

Objective To describe the daily variability and patterns of pain, fatigue, depressed mood, and cognitive function in persons with multiple sclerosis (MS). Design Repeated-measures observational study of seven consecutive days of home monitoring, including ecological momentary assessment (EMA) of symptoms. Multilevel mixed models were used to analyze data. Setting General community. Participants Ambulatory adults (N=107) with MS recruited through [Masked] and surrounding community. Interventions Not applicable. Main Outcome Measure(s) EMA measures of pain, fatigue, depressed mood, and cognitive function rated on a 0–10 scale, collected five times a day for seven days. Results Cognitive function and depressed mood exhibited more stable within-person patterns compared to pain and fatigue, which varied considerably within-person. All symptoms increased in intensity across the day (all p<0.02) with fatigue showing the most substantial increase. Notably, this diurnal increase varied by sex and age; women showed a continuous increase from wake to bedtime, whereas fatigue plateaued after 7PM for men (wake-bed B=1.04, p=0.004). For the oldest subgroup, diurnal increases were concentrated to the middle of the day compared to younger subgroups, which showed an earlier onset of fatigue increase and sustained increases until bed time (wake-3pm B=0.04, p=0.01; wake-7pm B=0.03, p=0.02). Diurnal patterns of cognitive function varied by education; those with advanced college degrees showed a more stable pattern across the day, with significant differences compared to those with bachelor-level degrees in the evening (wake-7pm B=−0.47, p=0.02; wake-bed B=−.45, p=0.04). Conclusions Findings suggest that chronic symptoms in MS are not static, even over a short time frame; rather, symptoms –fatigue and pain in particular - vary dynamically across and within days. Incorporation of EMA methods should be considered in the assessment of these chronic MS symptoms to enhance assessment and treatment strategies.

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