The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey

Abstract

Objective: Examination of prevalence, intensity and associations of pain in persons with multiple sclerosis (MS). Design: Multicenter, international cross-sectional survey. Setting: Patients were recruited from seven MS centers: in Serbia (Clinic of Neurology, Clinical Center of Serbia, Belgrade; Clinic of Neurology, Military Medical Academy, Belgrade; Clinic of Neurology, Clinical Center Kragujevac; Clinic of Neurology, Clinical Center Nis; Department of Neurology, General Hospital-Uzice), in Republic of Srpska-Bosnia and Herzegovina (Clinic of Neurology, Clinical Center Banja Luka) and in Croatia (University Department of Neurology, Sestre Milosrdnice University Hospital Center, Zagreb). Subjects: Six hundred and fifty consecutive MS patients diagnosed according to the Revised McDonald criteria (2005), from the aforementioned centers, over the period of 6 months. Methods: A semistructured questionnaire was administered during a face-to-face interview with neurologists who also performed Expanded Disability Status Scale (EDSS), the Hamilton Rating Scale for Depression (HDRS) and Hamilton Rating Scale for Anxiety (HARS). To recognize predictive factors for the presence of pain, the linear regression analysis was used. Results: Lifetime prevalence of pain was 66.5% (point prevalence=44.3%). The prevalence of the comorbidity of pain and depression was 29.1%. Older age (P<0.001), primary-progressive MS (P=0.034), higher EDSS score (P=0.008), higher scores of HDRS (P<0.001), and HARS (P<0.001) were significantly associated with pain. Finally, in our multivariate linear regression analysis, anxiety (P<0.001) was the independent predictor of pain. Conclusions: We confirmed high prevalence of pain, affecting approximately more than half of patients during the course of MS. Pain in MS is associated with disability, depression and, especially with anxiety, which has significant implications for treatment.