Illness and Demographic Correlates of Chronic Pain Among a Community-Based Sample of People With Multiple Sclerosis

Abstract 

Douglas C, Wollin JA, Windsor C. Illness and demographic correlates of chronic pain among a community-based sample of people with multiple sclerosis.

Objective

To investigate the prevalence, nature, and correlates of pain among a community-based sample with multiple sclerosis (MS).

Design

A cross-sectional survey and structured pain interview.

Setting

Community.

Participants

People with MS (N=219) recruited through systematic sampling from a randomly ordered MS society membership database.

Interventions

Not applicable.

Main Outcome Measures

Pain presence or absence, pain intensity (numeric rating scales), pain quality (McGill Pain Questionnaire), pain location(s) and extent (pain drawing), pain duration and frequency, provoking and relieving pain factors, and pain management techniques.

Results

Pain was common with some 67.1% of the sample reporting pain during the 2 weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these subjects experience chronic pain conditions characterized by moderate-to-severe pain intensity. Among those with pain, 75% reported pain in 3 or more locations, with participants reporting an average of 4.0±1.8 distinct pain sites. Women and people with more severe MS-related disability were significantly more likely to report both the presence of pain and greater pain intensity. In contrast, being in a married or in a de facto relationship and longer time since MS diagnosis were significantly associated with lower pain intensity.

Conclusions

Given the high prevalence and nature of pain experienced by people with MS, health care providers need to approach pain with a priority similar to that given to other MS-related problems such as mobility and functional independence. Women and people with more severe MS-related disability appear to be at particular risk for significant pain problems and therefore these groups warrant particular attention, such that routine clinical assessment should trigger routine pain assessment.

Key Words: Multiple sclerosis, Pain, Prevalence, Rehabilitation

List of Abbreviations: BPI, Brief Pain Inventory, CI, confidence interval, EDSS, Expanded Disability Status Scale, GNDS, Guy's Neurological Disability Scale, MPQ, McGill Pain Questionnaire, MS, multiple sclerosis, NRS, numeric rating scale, NSAID, nonsteroidal anti-inflammatory drug, OR, odds ratio, PRI, pain rating index