Psychiatric and physical comorbidities and pain in patients with multiple sclerosis

Rogier Scherder,1 Neeltje Kant,2 Evelien T Wolf,3 Bas Pijnenburg,4 Erik JA Scherder3 1Department of Orthopedics, Westfries Gasthuis, Hoorn, 2Department of Neuropsychology, Reade, Amsterdam, 3Department of Clinical Neuropsychology, Vrije Universiteit, Amsterdam, 4Acibadem International Medical Center, Amsterdam, the Netherlands Background: It has been observed that patients with multiple sclerosis (MS), who have psychiatric and physical comorbidities such as depression and COPD, have an increased risk of experiencing more pain. In this study, we have distinguished between pain intensity and pain affect, as the latter, particularly, requires treatment. Furthermore, while pain and comorbidities have been assessed using questionnaires, this is possibly a less reliable method for those who are cognitively vulnerable. Objective: The aim of this study was to determine whether psychiatric and physical comorbidities can predict pain intensity and pain affect in MS patients, susceptible to cognitive impairment.Methods: Ninety-four patients with MS and 80 control participants participated in this cross-sectional study. Besides depression and anxiety, 47 additional comorbidities were extracted from patients’ medical records. Depression and anxiety were assessed using the Beck Depression Inventory and the Symptom Check List-90. Pain was assessed using the Number of Words Chosen Affective, Coloured Analog Scale, and the Faces Pain Scale. Cognitive functions, for example, memory and executive functions, were assessed using several neuropsychological tests.Results: The main findings indicate that psychiatric comorbidities (depression and anxiety) predict both pain intensity and pain affect and that total physical comorbidity predicts only pain affect in MS patients, susceptible to cognitive impairment.Conclusion: Both psychiatric and physical comorbidities predict pain affect. All three clinical outcomes enhance MS patients’ suffering. Keywords: multiple sclerosis, pain, comorbidities, mood, cognition