Psychosocial factors linked to pain in multiple sclerosis

By Eleanor McDermid, Senior medwireNews Reporter

Psychosocial factors are important and potentially modifiable determinants of persistent pain in patients with multiple sclerosis (MS) who are taking pain medication, research shows.

In an analysis of 608 MS patients, psychosocial factors explained 24% of the variance in pain severity and 30% of the variance in pain interference – more than demographical and disease variables, which together explained 19% and 26%, respectively.

And 85% of the patients surveyed had a Brief Pain Inventory Short Form score in the moderate-to-severe range, with 96% reporting chronic pain of more than 6 months’ duration. This was despite 93% of patients using pain medications; 72% used two or more medications but only achieved around a 50% pain reduction.

“These initial findings suggest that pain is an important problem and biomedical approaches to MS-associated pain may benefit from a broader perspective”, write Rona Moss-Morris (King's College Hospital, London, UK) and study co-authors in the European Journal of Neurology.

Pain was the MS symptom that was most commonly rated as interfering, although patients rated it behind fatigue, sexual dysfunction and balance difficulties in terms of the severity of interference.

The psychosocial variables assessed included anxiety and depression, pain catastrophizing, pain acceptance, cognitive fusion, avoidance–endurance behaviour and pain perceptions.

Even after removing the emotional component (ie, anxiety and depression) from the analysis the researchers found that psychosocial variables still explained 23% and 28% of the variance in pain severity and interference, respectively, “suggesting that the effects are not just due to negative mood.”

The team points out that patients with more severe and interfering pain had more pain catastrophizing, were likely to view pain as being persistent over time with serious consequences and tended to avoid social and physical activities.

Yet patients’ pain endurance, in the form of persisting with activity, had no particular relationship with pain outcomes, “suggesting that maintaining activity does not worsen pain whilst avoidance does”, say the researchers. “Many patients are told by health professionals to rest when in pain and this may in fact not be the best advice.”

However, they caution that their study cannot establish the direction of causality, although they say that “[f]rom a clinical perspective, disease factors interact in a reciprocal way with the psychosocial factors”, suggesting that to intervene might be to break a vicious circle of psychosocial factors and pain.

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