Pain and Psychosocial Factors in Multiple Sclerosis Population

Background: Pain is common in multiple sclerosis (MS), however, little research has evaluated the influence of modifiable psychosocial variables, such as kinesiophobia (fear of movement), catastrophizing, depression, and anxiety on pain in people with MS. 

Objectives: This study aims to evaluate the relationship between these psychosocial variables and the pain experience, including pain interference (the extent to which pain interferes with daily living) in people with MS.  

Methods: Participants were 61 adults with MS recruited from a larger ongoing study at the MS Clinic within Holy Name Medical Center in New Jersey. They were predominantly female (70.5%) with mean age of 48 years (SD = 11.66) and of white descent (70.5%). Most were diagnosed with relapsing remitting MS (82%). Pain was evaluated using the Numeric Rating Scale (NRS; 0-10) and PROMIS Pain Interference Short Form 8a (PI), and was coded in three groups: No Pain (NRS = 0), Pain with low PI (NRS ≥ 1 and PI ≤ 26.5), and Pain with High PI (NRS ≥ 1 and PI > 26.5). Participants completed surveys of the Hospital Anxiety and Depression scale (HADS), Tampa Scale for Kinesiophobia (TSK), and the Pain Catastrophizing Scale (PCS). Separate multinomial logistical regressions evaluated the differences between pain groups on psychosocial factors.

Results: No pain was reported by 37.7% of the sample, 31.1% reported pain with low PI, (n = 19), and 31.1% reported pain with high PI (n = 19). Pain with high PI was associated with higher reporting of all psychosocial factors compared to no pain (TSK OR = 1.19, 95% CI = [1.06, 1.32];  PCS OR = 1.10, 95% CI = [1.04, 1.17]; depression OR = 1.42, 95% CI = [1.16, 1.73]; anxiety OR =  1.35, 95% CI = [1.13, 1.62]) and pain with low PI (TSK OR = 1.16, 95% CI = [1.04, 1.29]; PCS OR = 1.07, 95% CI = [1.01, 1.13]; depression OR = 1.29, 95% CI = [1.08, 1.54]; anxiety OR = 1.23, 95% CI = [1.04, 1.46]). Within catastrophizing, pain with high PI was associated with higher rumination, magnification and helplessness compared to no pain, and pain with high PI was associated with higher helplessness compared to those in pain with low PI.

Conclusions: Higher levels of pain interference was associated with higher levels of kinesiophobia, catastrophizing, depression, and anxiety. Future research should evaluate the efficacy of targeting these modifiable factors to reduce the pain experience in people with MS.