Ecological Momentary Assessment of Pain, Fatigue, Depressive, and Cognitive Symptoms Reveals Significant Daily Variability in Multiple Sclerosis



      To describe the daily variability and patterns of pain, fatigue, depressed mood, and cognitive function in persons with multiple sclerosis (MS).


      Repeated-measures observational study of 7 consecutive days of home monitoring, including ecological momentary assessment (EMA) of symptoms. Multilevel mixed models were used to analyze data.


      General community.


      Ambulatory adults (N=107) with MS recruited through the University of Michigan and surrounding community.


      Not applicable.

      Main Outcome Measure

      EMA measures of pain, fatigue, depressed mood, and cognitive function rated on a 0 to 10 scale, collected 5 times a day for 7 days.


      Cognitive function and depressed mood exhibited more stable within-person patterns than pain and fatigue, which varied considerably within person. All symptoms increased in intensity across the day (all P<.02), with fatigue showing the most substantial increase. Notably, this diurnal increase varied by sex and age; women showed a continuous increase from wake to bedtime, whereas fatigue plateaued after 7 pm for men (wake–bed B=1.04, P=.004). For the oldest subgroup, diurnal increases were concentrated to the middle of the day compared with younger subgroups, which showed an earlier onset of fatigue increase and sustained increases until bed time (wake–3 pm B=.04, P=.01; wake–7 pm B=.03, P=.02). Diurnal patterns of cognitive function varied by education; those with advanced college degrees showed a more stable pattern across the day, with significant differences compared with those with bachelor-level degrees in the evening (wake–7 pm B=−.47, P=.02; wake–bed B=−.45, P=.04).


      Findings suggest that chronic symptoms in MS are not static, even over a short time frame; rather, symptoms—fatigue and pain in particular—vary dynamically across and within days. Incorporation of EMA methods should be considered in the assessment of these chronic MS symptoms to enhance assessment and treatment strategies.


      List of abbreviations:

      BPA (Brief Pain Inventory), EMA (ecological momentary assessment), EOD (end-of-day), MS (multiple sclerosis), PROMIS (Patient-Reported Outcomes Measurement Information System)
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