Michalski D, et al. Pain in patients with multiple sclerosis: a complex assessment including quantitative and qualitative measurements provides for a disease-related biopsychosocial pain model. J Pain Res. 2011;4:219-25. Epub 2011 Aug 2.
Background: Pain of various causes is a common phenomenon in MS’ers. This study aimed to investigate pain in MS.
Methods: Pain intensity (NRS) and quality (SES) were measured in 38 consecutive outpatients with MS (mean age, 42.0 ± 11.5 years, 82% women). Pain-related behavior (FSR), health care utilization, bodily complaints (GBB-24) and fatigue (WEIMuS) were assessed by questionnaires, and MS-related neurological impairment by a standardized neurological examination (EDSS).
Results: Mean pain intensity was 4.0 (range, 0-10) and mean EDSS 3.7 (range, 0-8) in the overall sample. Currently present pain was reported by 81.6% of all patients. Disease duration and EDSS did not differ between patients with and without pain and were not correlated to quality or intensity of pain. Patients with pain had significantly higher scores of musculoskeletal complaints, but equal scores of exhaustion, gastrointestinal and cardiovascular complaints. Pain intensity correlated only with physical aspects, whereas quality of pain was additionally associated with increased avoidance, resignation and cognitive fatigue.
Conclusion: As in other conditions, pain in MS must be assessed in a multidimensional way. Further research should be devoted to adapt existing models to a MS-specific model of pain.
“I am not surprised that 82% of MS’ers attending routine outpatient clinics had current pain. It is one of the questions we routinely ask MS’ers in clinic. The neurological mechanisms that underlie pain in MS are numerous and complex. However, MS’ers are also liable to develop other painful conditions, for example degenerative spine disease, so you always have to ask yourself can there be another cause for the pain that may require further investigation and a different form treatment?”
“MS-related pain is often difficult to treat and is often refractory to medication or the medications cause intolerable side-effects.”
“Pain is another unmet need in MS; we need better drugs that are better tolerated!”
“Do any of you suffer from pain? It would be interesting to hear your perspective on it and how well it is managed.”