Pain, Fatigue, and Cognitive Symptoms Are Temporally Associated Within but Not Across Days in Multiple Sclerosis

Abstract

Objective To examine the temporal associations, within-day and day-to-day, between pain, fatigue, depressed mood, and cognitive function in multiple sclerosis (MS). Design Repeated-measures study involving seven days of ecological momentary assessment (EMA) of symptoms five times a day. Multilevel mixed models were used to analyze data. Setting Community. Participants Ambulatory adults (N=107) with MS. Interventions Not applicable. Main Outcome Measure(s) EMA of pain, fatigue, depressed mood, and cognitive function rated on a 0–10 scale. Results Fatigue and pain were linked within-day such that higher pain was associated with higher subsequent fatigue (B=0.09, p=0.04; likewise, higher fatigue was associated with higher pain in the following time frame (B=0.05, p=0.04). Poorer perceived cognitive function preceded increased subsequent pain (B=0.08, p=0.007) and fatigue (B=0.10, p=0.01) within-day. Depressed mood was not temporally linked with other symptoms. In terms of day-to-day effects, a day of higher fatigue related to decreased next day fatigue (B=−0.16, p=0.01), and a day of higher depressed mood related to increased depressed mood the next day (B=0.17, p=0.01). There were no cross-symptom associations from one day to the next. Conclusions Findings provide new insights on how common symptoms in MS relate to each other and vary within and over days. Pain and fatigue show evidence of a dynamic bidirectional relation over the course of a day, and worsening of perceived cognitive function preceded worsening of both pain and fatigue. Most temporal associations between symptoms occur within the course of a day, with relatively little carry-over from one day to the next.

An observational cohort study on impact, dimensions and outcome of perceived fatigue in adult 5q-spinal muscular atrophy patients receiving nusinersen treatment

“…These effects have also been shown for general and mental fatigue in other neurological diseases, such as multiple sclerosis and Parkinson's disease [15,50,51]. Surprisingly, we found no effect of discomfort/ pain on perceived fatigue as it has been shown for various conditions [33,52,53]. A possible explanation might be that pain is not a primary symptom in SMA.…”

Psychiatric and physical comorbidities and pain in patients with multiple sclerosis

“…Not only does fatigue occur in the majority of MS patients – it is considered to be one of the most disabling symptoms of MS 54 – but a relationship between fatigue, pain, and cognition has also been previously described. 55 A positive relationship between pain and fatigue, and a negative relationship between cognitive functioning and both pain and fatigue, was observed. 55 Within the scope of the present study, it would be interesting to examine whether the relationship between fatigue and pain affect is stronger than between fatigue and pain intensity in MS patients.…”

“… 55 A positive relationship between pain and fatigue, and a negative relationship between cognitive functioning and both pain and fatigue, was observed. 55 Within the scope of the present study, it would be interesting to examine whether the relationship between fatigue and pain affect is stronger than between fatigue and pain intensity in MS patients.…”

Altered pressure pain thresholds and increased wind-up in adult patients with chronic back pain with a history of childhood maltreatment: a quantitative sensory testing study

“…is very similar to SPADE except that it adds the construct of cognitive difficulties given the importance of this symptom to human sickness behavior model. In a recent longitudinal study using environmental momentary assessment of dyscognition, pain, mood, and fatigue, a lagged relationship was identified among symptoms, suggesting that dyscognition may actually precede or trigger the rest of the symptom cluster (Kratz, Murphy, & Braley, 2017). These results underscore the importance of including cognitive problems in a symptom cluster for CS.…”