Beyond a physical symptom: the importance of psychosocial factors in multiple sclerosis pain

• Published in: European journal of neurology Vol. 22; no. 11; pp. 1443 - 1452
• Main Authors: Harrison, A. M., Silber, E., McCracken, L. M., Moss-Morris, R.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.11.2015; John Wiley & Sons, Inc
• Subjects: Adult; Chronic Pain - etiology; Chronic Pain - psychology; Cross-Sectional Studies; Female; Humans; Male; management; Middle Aged; Multiple sclerosis; Multiple Sclerosis - complications; Multiple Sclerosis - psychology; Neuralgia - etiology; Neuralgia - psychology; neuropathic pain; Pain; psychosocial factors; neuropathic pain; pain; psychosocial factors; adult; management; multiple sclerosis
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.12763

Background and purpose Pain affects around two‐thirds of people with Multiple Sclerosis (pwMS). Biomedical treatments show limited efficacy. A recently developed cognitive‐behavioural model of Multiple Sclerosis (MS) pain suggests several psychosocial factors may worsen pain and related disability. The current study investigated whether psychosocial factors drawn from this model explain significant amounts of the variance in pain severity and interference over and above measures of disease severity and pain subtype. Methods Six hundred and twelve pwMS experiencing pain completed a UK wide cross‐sectional survey including valid and reliable psychometric questionnaires. Hierarchical regressions determined the relative contribution of disease severity and psychosocial factors to predicting pain severity and interference. Results All psychosocial factors including distress, negative beliefs about pain and its consequences, and avoidance of activity, were related to pain outcomes, explaining a further 24% and 30% of the variance in pain severity and interference after controlling for demographic and disease variables. Findings were similar for neuropathic and non‐neuropathic pain subgroups. Conclusions All pwMS reported significant pain and associated disability even though over 90% were taking pain medication. Psychosocial factors identified as important in predicting pain severity and, to a greater extent, pain interference are potentially modifiable and may be important treatment targets for both pain subtypes.