Pain Characteristics and Associations with Quality of Life in Patients with Multiple Sclerosis in Lithuania

Abstract

Background and objectives: Even though pain in multiple sclerosis (MS) patients is common and possibly associated with reduced quality of life, its exact prevalence and characteristics remain vaguely understood. We aimed to estimate the true extent of pain and its associations with quality of life in Lithuanian MS patients and to compare this data with that of a control group. Materials and Methods: Data were collected prospectively at the Department of Neurology, Lithuanian University of Health Sciences Kaunas Clinics. A face-to-face structured interview and a questionnaire were used to collect demographic and clinical data of the MS (n = 120) and control (n = 120) groups. The Expanded Disability Status Scale (EDSS) was used to quantify disability in the MS group. Scores ≥4/10 in the Douleur Neuropathique 4 questionnaire were classified as neuropathic pain. Patients were evaluated using the anxiety and depression subsets of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D), the physical and mental component subsets of the Short Form-12 questionnaire (PSC-12 and MSC-12). Results: The MS and control groups did not differ in pain prevalence (76.7% vs. 65.9%, p = 0.064) or intensity. Lhermitte sign, lower limb, and face pain were more common in the MS group, whereas subjects in the control group were more often affected by lower back, neck, and joint pain. Neuropathic pain and pain lasting longer than 2 years were more common among pain-affected MS patients than among controls. MS patients with pain had higher EDSS, HADS-D, and HADS-A and lower PSC-12 scores than those without pain; however, no difference was found regarding the duration of MS or age. Males with MS and pain had higher MSC-12 and HADS-D scores in comparison to the same subset of females. Conclusions: Pain affects approximately three out of four patients with MS in Lithuania and is negatively associated with the mental and physical aspects of quality of life.

Pain syndrome patterns and their characteristics in multiple sclerosis patients

“…Despite the lack of data on the characteristics of pain intensity in patients with MS with different patterns, many studies have assessed the intensity of pain in MS at the time of the examination. In most studies, pain at the time of examination was moderate, which corresponds to the characteristics of pain intensity at the time of examination of our sample of patients [8,9,10]. When assessing the characteristics of pain intensity in different patterns, it was found that the same highest scores of pain intensity in patients with MS at the time of the study were with constant pain (pattern 1, p=0.01 with 3 pattern) and constant pain with severe attacks (pattern 2, p<0.05 with 3 and 4 patterns): 5.0 [3.0; 7.0] points.…”

“…These data can be compared with first and fourth patterns (56.7%), which are characterized by the presence of constant moderately intense pain. Also recently published studies conducted in Lithuania and Italy showed a prevalence of persistent pain in 26.1% and 52.1% of MS patients, respectively, with a Lithuanian study showed that more than half of MS patients had pain for more than 2 years, and in Italian, that 78.9% had pain attacks more often than once a week [8,9].…”

“…Ö³ äàí³ ìîaeíà ïî-ð³âíÿòè ç 1 ³ 4 ïàòåðíàìè ïåðåá³ãó (56,7%), äëÿ ÿêèõ õàðàêòåðíà íàÿâí³ñòü ïîñò³éíîãî äîñèòü ³íòåíñèâíîãî áîëþ. Òàêîae íåùîäàâíî áóëè îïóáë³êîâàí³ äîñë³äaeåííÿ, ïðîâåäåí³ â Ëèòâ³ òà ²òà볿, ÿê³ ïðîäåìîíñòðóâàëè ïîøè-ðåí³ñòü ïîñò³éíîãî áîëþ â 26,1% ³ 52.1% â³ä-ïîâ³äíî, ïðè öüîìó ó Ëèòîâñüêîìó äîñë³-äaeåíí³ çàçíà÷åíî, ùî á³ëüøà ïîëîâèíà öèõ õâîðèõ ìຠáîëüîâ³ ñèíäðîìè ïîíàä 2 ðîêè, à â ²òàë³éñüêîìó, ùî 78.9% ìàëè íàïàäè áîëþ ÷àñò³øå, í³ae 1 ðàç íà òèaeäåíü [8,9].…”

“…Ïîïðè â³äñóòí³ñòü äàíèõ, ùîäî õàðàêòåðèñòèê ³íòåíñèâíîñò³ áîëþ ó ïàö³ºí-ò³â ç ÐÑ ïðè ð³çíèõ éîãî ïàòåðíàõ, ó áàãàòüîõ äîñë³äaeåííÿõ âèçíà÷àëàñÿ îö³íêà ³íòåíñèâ-íîñò³ áîëþ ïðè ÐÑ íà ìîìåíò îáñòåaeåííÿ. Ó á³ëüøî¿ ê³ëüêîñò³ äîñë³äaeåíü á³ëü íà ìîìåíò îáñòåaeåííÿ áóâ ïîì³ðíèì, ùî â³äïîâ³äຠõàðàêòåðèñòèêàì ³íòåíñèâíîñò³ áîëþ íà ìîìåíò îáñòåaeåííÿ íàøî¿ âèá³ðêè ïàö³ºíò³â [8,9,10]. Ïðè îö³íö³ õàðàêòåðèñòèê ³íòåíñèâíîñò³ áîëþ ïðè ð³çíèõ ïàòåðíàõ ïåðåá³ãó, âñòàíîâèëè, ùî îäíàêîâ³ íàéâèù³ áàëè ³íòåíñèâíîñò³ áîëþ ó õâîðèõ íà ÐÑ íà ìîìåíò äîñë³äaeåííÿ áóëè ïðè ïîñò³éíîìó áîë³ (ïàòåðí 1, ð=0,01 ³ç 3 ïàòåðíîì) òà ïîñò³éíîìó áîë³ ç âèðàaeåíèìè íàïàäàìè (ïàòåðí 2, ð<0,05 ³ç 3 òà 4 ïàòåðíàìè): 5,0 [3,0; 7,0] áàë³â.…”

Psycho-Emotional Aspects in the Formation of Pain Syndrome Characteristics in Patients With Multiple Sclerosis

“…According to meta-analysis, 63% of MS patients have pain syndromes. However, in some studies, especially those published in recent years, these fi gures reach 90% (5)(6)(7)(8). Depression and anxiety are also common in case of MS and are manifested more as compared to the general population.…”