Pain in People with Multiple Sclerosis: Associations with Modifiable Lifestyle Factors, Fatigue, Depression, Anxiety, and Mental Health Quality of Life.

Claudia H Marck,Alysha M De Livera,Fary Khan,George A Jelinek,Pia L Jelinek,Keryn L Taylor,Sandra L Neate,Chelsea R Brown,Tracey J Weiland

doi:10.3389/fneur.2017.00461

Claudia H Marck, Alysha M De Livera + Show 7 more

Open Access

https://doi.org/10.3389/fneur.2017.00461

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Abstract

People with multiple sclerosis (MS) often experience pain, which can interfere with mobility, employment, and quality of life (QOL). This cross-sectional study explored associations between pain, demographic, disease, and modifiable lifestyle factors in an international sample of people with MS recruited online. Substantial pain, of moderate/severe intensity and interfering at least moderately with work/household or enjoyment of life in the past 4 weeks, was reported by 682/2,362 (28.9%). Substantial pain was associated with fatigue (odds ratio (OR): 6.7, 95% confidence interval (CI): 4.9,9.3), depression (OR:4.0, 95% CI:3.2,5.1), anxiety (OR:2.4, 95% CI:1.9,2.9), and lower mental health QOL (Mean Difference: -14.7, 95% CI:-16.6,-12.8). Regression analyses showed that smoking (OR: 2.0, 95% CI:1.35,2.87) and obesity (OR:2.1, 95% CI: 1.5,2.8), moderate alcohol use (OR: 0.7, 95% CI:0.5,0.9), moderate (OR 0.7, 95% CI: 0.55,0.98) or high (OR 0.6, 95% CI: 0.4,0.8) physical activity level, and healthy diet (OR 0.8, 95% CI: 0.75,0.95, per 10 points) were associated with substantial pain. Our results show clear associations with modifiable lifestyle factors and substantial pain in MS. These factors are already considered in the prevention and management of pain in other populations but have not previously been considered in MS. Conversely, pain and associated common MS comorbidities, such as depression, anxiety, and fatigue, may hamper efforts to start or maintain healthy behaviors. Strategies to overcome these barriers need to be considered. Further research should clarify the direction of these associations.

Highlights

Multiple sclerosis (MS) is a neurological disorder with variable disease course and diverse symptomatology
We explored the association between several modifiable lifestyle factors as exposures and substantial pain as the outcome in a multivariable regression model adjusted for age, gender, duration of multiple sclerosis (MS) and level of disability
Pain is common in people with MS (PwMS) and contributes significantly to disability [11, 12] and worse quality of life (QOL) [13, 14]

Summary

Introduction

Multiple sclerosis (MS) is a neurological disorder with variable disease course and diverse symptomatology. One case–control study in PwMS found a similar prevalence of pain to controls [Odds Ratio (OR) 0.99–1.13], but showed that PwMS had more severe pain than controls, comparable to people with arthritis [8]. Another study showed that both pain severity and interference was greater in PwMS than controls, but these differences were only significant in some, mostly older age groups [9]. PwMS more often require pharmacological treatment [10] and pain can significantly interfere with daily activities [11] and employment [12] and affect quality of life (QOL) [13,14,15]. People with multiple sclerosis (MS) often experience pain, which can interfere with mobility, employment, and quality of life (QOL)

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