Pain affects depression through anxiety, fatigue, and sleep in multiple sclerosis.

Abstract

Objective Over a quarter million individuals in the US have Multiple Sclerosis (MS). Chronic pain and depression are disproportionately high in this population. The purpose of this study was to examine the relationship between chronic pain and depression in MS and to examine potentially meditational effects of anxiety, fatigue and sleep. Methods Cross-sectional data from self-reported instruments measuring multiple symptoms and quality of life indicators were used in this study. Structural equation modeling (SEM) was utilized to model direct and indirect effects of pain on depression in a sample of 1245 community dwelling individuals with MS. Pain interference, depression, fatigue and sleep disturbance were modeled as latent variables with 2 to 3 indicators each. The model controlled for age, sex, disability status (EDSS) and social support. Results A model with indirect effects of pain on depression had adequate fit and accounted for nearly 80% of the variance in depression. The effects of chronic pain on depression were almost completely mediated by fatigue, anxiety, and sleep disturbance. Higher pain was associated with greater fatigue, anxiety, and sleep disturbance, which in turn were associated with higher levels of depression. The largest mediating effect was through fatigue. Additional analyses excluded items with common content and suggested that the meditational effects observed were not attributable to content overlap across scales. Conclusions Individuals living with MS who report high levels of chronic pain and depressive symptoms may benefit from treatment approaches that can address sleep, fatigue, and anxiety.

Differences in demographic, clinical, and symptom characteristics and quality of life outcomes among oncology patients with different types of pain

“…Consistent with previous reports of patients with CP 32,39 and NCP, 1,34,47 the occurrence of moderate to severe pain was associated with a higher symptom burden. The severity of depression and anxiety differed among the pain groups.…”

Ten-year follow-up of health-related quality of life among ambulatory persons with multiple sclerosis at baseline

“…To our knowledge, deterioration on the pain scale has not been reported in previous epidemiological or clinical studies using the RAND-36 or MSQOL-54 instruments [20][21][22][23] although the presence of chronic pain among PwMS has been noted [36][37]. Our study indicated deterioration in sexual activity on the 15D and the MSQOL-54 as well as in satisfaction with 9 sexual functioning on the MSQOL-54.…”

Overview: a Framework for the Discussion of Sleep in Multiple Sclerosis

“…Depression shares a bidirectional relationship with insomnia, and may be exacerbated by the condition. [37] Chronic pain may also be exacerbated by insomnia in patients with MS, and a recent study suggests that poor sleep partially mediates the relationship between pain and depression in MS patients, making this an important component to consider in the treatment of depression [38]. A recent study using functional MRI also suggests an association between insomnia and subjective (though not objective) measures of cognitive function, as well as decreased thalamic functional connectivity [39].…”