The co-occurrence of pain and depression in adults with multiple sclerosis.

Abstract

Purpose/Objective To define the rates of pain, depression, and their co-occurrence in persons with multiple sclerosis (MS). Research Method/Design Participants were 161 persons with MS who previously participated in research and indicated a willingness to be contacted for future studies. Data were collected via postal survey and included the Patient Health Questionnaire—9 for depressive symptoms and a numerical rating scale (0–10) for pain. Descriptive statistics, chi-square analyses, and odds ratios were calculated to describe the prevalence, difference, and likelihood of depression, pain, and their comorbidity. Results Some level of pain was experienced by 73% of the sample, with 40% of the entire sample reporting moderate or worse pain severity. Clinically significant levels of depressive symptoms were reported by 22% of the sample, and 8% reported sufficient symptoms to meet major depressive episode diagnostic criteria. Of persons meeting depression criteria, 86–100% reported experiencing any pain; 67–77% of persons meeting depression criteria reported experiencing pain of at least moderate severity. Of persons experiencing any pain, 11–34% met depression criteria; 15–37% of persons experiencing pain of at least moderate severity met depression criteria. Conclusions/Implications Pain and depression co-occur frequently in persons with MS. However, it is more common for individuals with depression to report pain than for individuals with pain to endorse symptoms of depression. Future studies should explore the implications of this co-occurrence, such as whether these individuals experience greater levels of disability, higher medical costs, or fewer benefits from treatment than persons with either condition alone.

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

“…Significant correlations between average symptom levels are consistent with previous cross-sectional research concluding that pain, fatigue, and depressive and cognitive symptoms often cluster together in ms 4,23,26,27,29,30,48–50 . Taken together, these findings underscore the importance of considering both between-person and within-person processes; for example, although the extant data support the hypothesis that people who report higher depressed mood also report higher pain, these data suggest that when a person feels particularly depressed, they are not more likely to experience a subsequent increase in pain on a typical day.…”

“…Research examining associations between commonly comorbid symptoms in MS is increasing. For instance, studies that have considered multiple MS symptoms have consistently identified pain, fatigue, depressed mood 23, 26–30 , and cognitive problems 24, 31 as symptoms that cluster together. Although these studies have advanced our understanding of how symptoms correlate in MS, a number of questions about the nature of these symptoms remain.…”

Towards a better understanding of MS pain: A systematic review of potentially modifiable psychosocial factors

“…One medium quality study [64] showed that headache severity and depression (BDI-II) were unrelated. In terms of odds ratios, one medium [65] and one good quality study [66] showed that MS participants meeting the depression criteria were 1.196-2.070 times more likely to meet the pain criteria (greater severity) relative to non-depressed MS participants.…”

Resources evaluation in patients with multiple sclerosis: A moderation effect of time since diagnosis

“…This may be a result of the occurrence of secondary psychopathological symptoms during the illness, of which the most common are depressive symptoms in about 11%-34% (Alschuler, Ehde, & Jensen, 2013) of multiple sclerosis patients and fatigue in about 70%. The fatigue is considered one of the disease's three main symptoms (Losy, 2005).…”