The type and intensity of pain in multiple sclerosis; the relationship between pain and functionality, disability, quality of life
The aim of this study was to define the pain/neuropathic pain-related factors, to evaluate the patients with pain in terms of neuropathic pain and to determine the relationship between pain/neuropathic pain and disability, functionality, daily living activities, fatigue, emotional state and quality of life in Multiple Sclerosis (MS).
This study was conducted in Neurology and Physical Medicine and Rehabilitation clinics of Necmettin Erbakan University, Meram Faculty of Medicine, between July 2017 and October 2017. One hundred patients over 18 years of age, diagnosed with Multiple Sclerosis according to McDonald Criteria 2010. Neuromusculoskeletal examinations of the patients were performed. Patients’ age, gender, education level, marital status, family support, duration of illness, MS type, locations of MS plaques were obtained. We used Krutzke Expanded Disability Status Scale (EDSS) to evaluate disability, Barthel Index of Activities of Daily Living to evaluate activities of daily living, Fatigue Severity Scale (FSS) to evaluate severity of fatigue, Beck Depression Inventory to evaluate depression, Nottingham Health Profile to evaluate quality of life, Functional ambulation classification scale to evaluate ambulation ability. Patients were divided into two groups with and without pain. These two groups were compared in terms of sociodemographic informations, disease data and disability, functionality, daily life activities, fatigue severity, mood and quality of life. In patients with pain, we used Pain Detect Questionnaire (PD- vii Q) to identify neuropathic components of their pain. According to PD-Q patients with pain divided into two groups with and without neuoropathic component. Also these two groups were compared in terms of sociodemographic information, disease data and disability, functionality, daily life activities, fatigue severity, mood and quality of life.
62% of the patients had pain symptom. In our study, no relation was found between pain and age, gender, marital status, family support, type of MS, duration of disease, plaque placement, disability, functionality, daily life activities. Patients with pain had lower education level than patients without pain. In patients with pain, the severity of fatigue and depressive symptoms were higher; the quality of life was lower. Lhermitte sign was present in 16 patients, painful tonic spasm in 3 patients and trigeminal neuralgia in 1 patient. The most common headache (38%) and diffuse lower extremity pain (25%) were observed in the patients. 29.03% of the patients with pain had a neuropathic component of pain. Only 22.22% of patients with neuropathic component of pain were taking medication for this symptom. While there was no relationship between neuropathic pain and age, gender, education level, marital status, family support, type of MS, duration of disease, plaque placement, functionality, daily living activities, depression; pain severity and fatigue severity were higher and quality of life was lower in these patients.
In our study, pain was found as a common symptom in MS patients. Pain complaint was found to be associated with increased fatigue, depressive mood and low education level and quality of life. Neuropathic pain was associated with increased pain severity, fatigue and low quality of life. The number of patients receiving correct treatment for their complaints was low. We believe that pain and neuropathic pain should be questioned and treated better by physicians because it is a symptom that is common in MS disease and adversely affects the quality of life of patients.
Keywords: Multiple sclerosis, Pain, Neuropathic pain, Quality of life
– Study made by Zerrin Kasap