Pain, Depression, and Quality of Life in Neuromyelitis Optica Spectrum Disorder

Abstract

ObjectivesTo evaluate prevalence, clinical characteristics, and predictors of pain, depression, and their impact on the quality of life (QoL) in a large neuromyelitis optica spectrum disorder (NMOSD) cohort.MethodsWe included 166 patients with aquaporin-4–seropositive NMOSD from 13 tertiary referral centers. Patients received questionnaires on demographic and clinical characteristics, PainDetect, short form of Brief Pain Inventory, Beck Depression Inventory–II, and Short Form 36 Health Survey.ResultsOne hundred twenty-five (75.3%) patients suffered from chronic NMOSD-associated pain. Of these, 65.9% had neuropathic pain, 68.8% reported spasticity-associated pain and 26.4% painful tonic spasms. Number of previous myelitis attacks (OR = 1.27, p = 0.018) and involved upper thoracic segments (OR = 1.31, p = 0.018) were the only predictive factors for chronic pain. The latter was specifically associated with spasticity-associated pain (OR = 1.36, p = 0.002). More than a third (39.8%) suffered from depression, which was moderate to severe in 51.5%. Pain severity (OR = 1.81, p < 0.001) and especially neuropathic character (OR = 3.44, p < 0.001) were associated with depression. Pain severity and walking impairment explained 53.9% of the physical QoL variability, while depression and walking impairment 39.7% of the mental QoL variability. No specific medication was given to 70.6% of patients with moderate or severe depression and 42.5% of those with neuropathic pain. Two-thirds (64.2%) of patients with symptomatic treatment still reported moderate to severe pain.ConclusionsMyelitis episodes involving upper thoracic segments are main drivers of pain in NMOSD. Although pain intensity was lower than in previous studies, pain and depression remain undertreated and strongly affect QoL. Interventional studies on targeted treatment strategies for pain are urgently needed in NMOSD.

Identifying different cognitive phenotypes and their relationship with disability in neuromyelitis optica spectrum disorder

“…Einarsson et al concluded that lower disability was predictive of the capacity to perform the NHPT and walk 10 m in PwMS (40). Chronic pain, a frequent and one of the most disabling symptoms of NMOSD, was found to negatively affect the quality of life in a recent study (41). A further study on the association between pain and cognitive function is warranted (41).…”

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Review of Clinical and MRI Features, Diagnosis, and Management

“…Pain can be neuropathic, spasticity-associated, and/or secondary to painful tonic spasms (i.e., episodes of intense pain that accompany tonic postures of one or more limbs lasting 30-60 s). Given the strong correlation between pain and depression in these patients, effective treatment of pain can indirectly have a beneficial effect on depression, and vice versa (188,189). In the absence of dedicated trials, common pain medications include non-opioid analgesics, antidepressants (e.g., duloxetine), and antiepileptic agents (e.g., gabapentin, pregabalin).…”

“…Painful tonic spasms in particular generally respond well to low dose carbamazepine (200-300 mg/day) although are more common with AQP4-IgG+NMOSD than MOGAD (190). Initiation of immunosuppressive treatment has also been reported to improve pain (188,189). Muscle relaxants (e.g., baclofen, benzodiazepines) and physical rehabilitation should be offered for spasticity.…”

Experiences of social isolation among patients with neuromyelitis optica spectrum disorder in China: A qualitative study

“…Pain, fatigue, and cognitive dysfunction are common symptoms and important predictors of quality of life in patients with NMOSD (Ayzenberg et al, 2021;He et al, 2011;Mutch et al, 2014). Ayzenberg and colleagues showed that 75.3% of patients reported pain, and pain severity was associated with depression and significantly affected quality of life (Ayzenberg et al, 2021).…”

“…Pain, fatigue, and cognitive dysfunction are common symptoms and important predictors of quality of life in patients with NMOSD (Ayzenberg et al, 2021;He et al, 2011;Mutch et al, 2014). Ayzenberg and colleagues showed that 75.3% of patients reported pain, and pain severity was associated with depression and significantly affected quality of life (Ayzenberg et al, 2021). Mutch and colleagues reported that 80% and 46.7% of participants reported that pain and fatigue, respectively, significantly affected their daily life by affecting their activities, emotions, walking ability, life experiences, and interpersonal relationships (Mutch et al, 2014).…”