Abstract
The aim of this work is to examine the course and impact of chronic pain and pain-related disability in persons with multiple sclerosis (pwMS) over a 7-year period in the Australian community employing a longitudinal, cross-sectional study using structured interviews and validated measures. The intensity of chronic pain was assessed with the visual analogue scale (VAS); the chronic pain grade (CPG) classified pain severity using scores for both pain intensity and pain-related disability, and the assessment of quality of life (AQoL) questionnaire assessed impact on participatory domains. Of the 74 pwMS assessed at 7-year follow-up (T2), 53 (71.6 %) were female, with average age of 55.6 years, and median time since diagnosis of 16.5 years. At T2, 13 (13.8 %) more participants reported chronic pain compared with baseline assessment (T1), (61 vs. 74). Although there were no significant differences on average pain intensity rating between T1 and T2 (p = 0.65), more participants at T2 reported higher rates of pain (13.1 vs. 28.4 %). At T2, participants reported greater disability limiting their daily activities due to pain (16.2 vs. 0 %), and more deterioration and dependency suggested by the AQoL domains of “Independent living” (p < 0.001) and “Physical senses” (p = 0.013). At T2, pwMS used less pharmacological medication but accessed more “other” therapy to cope with their chronic pain. This study provides longitudinal insight into the complex multidimensional chronic pain-related disability in pwMS over a longer period. Improved clinician understanding of the course of chronic pain, early intervention, and patient self-management may decrease pain-related disability and contribute to their overall well-being.
Similar content being viewed by others
References
Ehde DM, Osborne TL, Jensen MP (2005) Chronic pain in persons with multiple sclerosis. Phys Med Rehabil Clin N Am 16:503–512
MS Society Australia (2012) MS Practice—for health professionals Melbourne, Victoria. www.msaustralia.org.au. Accessed 10 Dec 2012
Grasso MG, Clemenzi A, Tonini A et al (2008) Pain in multiple sclerosis: a clinical and instrumental approach. Mult Scler 14:506–513
Moulin DE, Foley KM, Ebers GC (1988) Pain syndromes in multiple sclerosis. Neurol 38:1830–1834
Boneschi FM, Colombo B, Annovazzi P et al (2008) Lifetime and actual prevalence of pain and headache in multiple sclerosis. Mult Scler 14:514–521
Ehde DM, Gibbons LE, Chwastiak L, Bombardier CH, Sullivan MD, Kraft GH (2003) Chronic pain in a large community sample of persons with multiple sclerosis. Mult Scler 9:605–611
Ehde DM, Osborne TL, Hanley MA, Jensen MP, Kraft GH (2006) The scope and nature of pain in persons with multiple sclerosis. Mult Scler 12:629–638
Kalia LV, O’Connor PW (2005) Severity of chronic pain and its relationship to quality of life in multiple sclerosis. Mult Scler 11:322–327
Archibald CJ, McGrath PJ, Ritvo PG et al (1994) Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients. Pain 58:89–93
Svendsen KB, Jensen TS, Overvad K, Hansen HJ, Koch-Henriksen N, Bach FW (2003) Pain in patients with multiple sclerosis: a population-based study. Arch Neurol 60:1089–1094
Warnell P (1991) The pain experience of a multiple sclerosis population: a descriptive study. Axone 13:26–28
Howarth AL (2000) Pain management for multiple sclerosis patients. Prof Nurse 16:824–826
Kerns RD, Kassirer M, Otis J (2002) Pain in multiple sclerosis: a biopsychosocial perspective. J Rehabil Res Dev 39:225–232
Pollmann W, Feneberg W (2008) Current management of pain associated with multiple sclerosis. CNS Drugs 22:291–324
Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ (2001) Chronic pain in Australia: a prevalence study. Pain 89:127–134
Blyth FM, March LM, Cousins MJ (2003) Chronic pain-related disability and use of analgesia and health services in a Sydney community. Med J Aust 179:84–87
Khan F, Pallant J (2007) Chronic pain in multiple sclerosis: prevalence, characteristics, and impact on quality of life in an Australian community cohort. J Pain 8:614–623
Khan F, Pallant JF, Amatya B, Young K, Gibson S (2011) Cognitive-behavioral classifications of chronic pain in patients with multiple sclerosis. Int J Rehabil Res 34:235–242
Von Korff M, Ormel J, Keefe FJ, Dworkin SF (1992) Grading the severity of chronic pain. Pain 50:133–149
Alschuler KN, Jensen MP, Ehde DM (2012) Defining mild, moderate, and severe pain in persons with multiple sclerosis. Pain Med 13:1358–1365
Stenager E, Knudsen L, Jensen K (1995) Acute and chronic pain syndromes in multiple sclerosis. A 5-year follow-up study. Ital J Neurol Sci 16:629–632
Kurtzke JF (1983) Rating neurological impairment in Multiple Sclerosis: an expanded disability rating scale (EDSS). Neurol 13:1444–1452
Polman CH, Reingold SC, Banwell B et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302
International Association for the Study of Pain: Subcommittee on Taxonomy (1986) Classification of Chronic Pain. Descriptors of chronic pain syndromes and definitions of pain terms. Pain Suppl 3:S1–S26
Kanner RM (1999) Treatment of chronic pain. Mult Scler Ther 38:541–546
Jensen MP, Karoly P (2001) Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack R (eds) Handbook of pain assessment. Guilford Press, USA, pp 15–34
MIMS Australia. Monthly Index of Medical Specialties Australia 2011. http://www.mims.com.au. Assessed: 14 Dec 2012
Heckman-Stone C, Stone C (2001) Pain management techniques used by patients with multiple sclerosis. J Pain 2:205–208
Hawthorne G, Richardson J, Osborne R (1999) The Assessment of quality of life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res 8:209–224
Hawthorne G, Osborne R (2005) Population norms and meaningful differences for the Assessment of Quality of Life (AQoL) measure. Aust N Z J Public Health 29:136–142
Hawthorne G, Richardson J, Day NA (2001) A comparison of the assessment of quality of life (AQoL) with four other generic utility instruments. Ann Med 33:358–370
Beiske AG, Pedersen ED, Czujko B, Myhr KM (2004) Pain and sensory complaints in multiple sclerosis. Eur J Neurol 11:479–482
Hirsh AT, Turner AP, Ehde DM, Haselkorn JK (2009) Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors. Arch Phys Med Rehabil 90:646–651
Solaro C, Brichetto G, Amato MP et al (2004) The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study. Neurology 63:919–921
World Health Organization (WHO) (2001) International classification of functioning, disability and health (ICF). WHO, Geneva
Svendsen KB, Jensen TS, Hansen HJ, Bach FW (2005) Sensory function and quality of life in patients with multiple sclerosis and pain. Pain 114:473–481
Freeman JA, Langdon DW, Hobart JC, Thompson AJ (1997) The impact of inpatient rehabilitation on progressive multiple sclerosis. Ann Neurol 42:236–244
Patti F, Ciancio MR, Reggio E et al (2002) The impact of outpatient rehabilitation on quality of life in multiple sclerosis. J Neurol 249:1027–1033
Truini A, Barbanti P, Pozzilli C, Cruccu G (2013) A mechanism-based classification of pain in multiple sclerosis. J Neurol 260:351–367
Acknowledgments
We thank all the participants in this study, Ms. L. Oscari for interviews, A/Prof. J. Pallant for statistical input, and Prof. T. Kilpatrick for access to the RMH MS Database.
Conflicts of interest
The authors have no conflicts of interest to report.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Khan, F., Amatya, B. & Kesselring, J. Longitudinal 7-year follow-up of chronic pain in persons with multiple sclerosis in the community. J Neurol 260, 2005–2015 (2013). https://doi.org/10.1007/s00415-013-6925-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-013-6925-z