Severity of chronic pain and its relationship to quality of life in multiple sclerosis

2005 ◽  
Vol 11 (3) ◽  
pp. 322-327 ◽  
Author(s):  
Lorraine V Kalia ◽  
Paul W OConnor

Introduction: This study used reliable and validated instruments to compare pain severity in multiple sclerosis (MS) to that in other chronic painful conditions, and to examine relationships between chronic pain in MS and health-related quality of life (HRQOL). Methods: Ninety-nine MS patients completed a self-administered survey comprised of the Medical Outcomes 36-Item Short-Form Health Survey, the Short-Form McGill Pain Questionnaire, and the Hospital Anxiety and Depression Scale. Results: Pain severity was not different between MS patients with pain and rheumatoid arthritis (P=0.77) or osteoarthritis (P=0.98) patients. Chronic pain in MS was less often neurogenic than non-neurogenic, although severity of neurogenic pain was greater than that of non-neurogenic pain (P=0.048). Chronic pain in MS was found to have no significant relationship to age, disease duration or disease course. Instead, we found that pain was correlated with aspects of HRQOL, particularly mental health (r=0.44, P<0.0001) versus physical functioning (r=0.19, P>0.05). Chronic pain was significantly related to anxiety and depression for females but not for males with MS. Conclusions: Chronic pain in MS is as severe as pain in arthritic conditions and is associated with reduced HRQOL. Thus, pain can be a significant symptom for MS patients and the need for treatment may be underestimated.

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 596
Author(s):  
Greta Veličkaitė ◽  
Neringa Jucevičiūtė ◽  
Renata Balnytė ◽  
Ovidijus Laucius ◽  
Antanas Vaitkus

Background and objectives: Even though pain in multiple sclerosis (MS) patients is common and possibly associated with reduced quality of life, its exact prevalence and characteristics remain vaguely understood. We aimed to estimate the true extent of pain and its associations with quality of life in Lithuanian MS patients and to compare this data with that of a control group. Materials and Methods: Data were collected prospectively at the Department of Neurology, Lithuanian University of Health Sciences Kaunas Clinics. A face-to-face structured interview and a questionnaire were used to collect demographic and clinical data of the MS (n = 120) and control (n = 120) groups. The Expanded Disability Status Scale (EDSS) was used to quantify disability in the MS group. Scores ≥4/10 in the Douleur Neuropathique 4 questionnaire were classified as neuropathic pain. Patients were evaluated using the anxiety and depression subsets of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D), the physical and mental component subsets of the Short Form-12 questionnaire (PSC-12 and MSC-12). Results: The MS and control groups did not differ in pain prevalence (76.7% vs. 65.9%, p = 0.064) or intensity. Lhermitte sign, lower limb, and face pain were more common in the MS group, whereas subjects in the control group were more often affected by lower back, neck, and joint pain. Neuropathic pain and pain lasting longer than 2 years were more common among pain-affected MS patients than among controls. MS patients with pain had higher EDSS, HADS-D, and HADS-A and lower PSC-12 scores than those without pain; however, no difference was found regarding the duration of MS or age. Males with MS and pain had higher MSC-12 and HADS-D scores in comparison to the same subset of females. Conclusions: Pain affects approximately three out of four patients with MS in Lithuania and is negatively associated with the mental and physical aspects of quality of life.


2009 ◽  
Vol 37 (4) ◽  
pp. 1108-1114 ◽  
Author(s):  
Y Chai ◽  
Y Shao ◽  
S Lin ◽  
K-Y Xiong ◽  
W-S Chen ◽  
...  

The potential impact of the surgical correction of strabismus on vision-related quality of life (VRQOL) and the symptoms of anxiety and depression in children with strabismus remain unclear. The present study included 60 children with strabismus: 30 with heterophoria and 30 with heterotropia. A healthy age-and gender-matched control group ( n = 60) was also recruited. The psychological instruments that were used were the short-form 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and the Hospital Anxiety and Depression Scale (HADS). The results demonstrated that eight of the 12 NEI-VFQ-25 subscales were significantly impaired in children with strabismus compared with matched controls. Compared with pre-operative values, significant improvements were noted after surgery in the NEI-VFQ-25 summary score, and the anxiety and depression scores. This study demonstrated that the NEI-VFQ-25 instrument can be used in strabismus children and that surgical interventions can improve VRQOL, anxiety and depression in strabismus patients.


2009 ◽  
Vol 102 (12) ◽  
pp. 1219-1226 ◽  
Author(s):  
Paul Lukas ◽  
René Krummenacher ◽  
Franziska Biasiutti ◽  
Stefan Begré ◽  
Hansjörg Znoj ◽  
...  

SummaryHealth-related quality of life (QoL) has been associated with several social and medical conditions in patients with deep vein thrombosis (DVT) and pulmonary embolism (PE).To the best of our knowledge,there is no study investigating the relationship of QoL with psychological variables in this patient population.We assumed as a hypothesis an association between heightened levels of fatigue and psychological distress, as well as decreased QoL in patients with an objectively diagnosed venous thromboembolic event. Study participants were 205 consecutively enrolled out-patients (47.4 years, 54.6% men) with DVT and/or PE. Approximately 10 days before blood collection for thrombophilia work-up, QoL, fatigue, and psychological distress were assessed using the Short Form Health Survey (SF-12), the Multidimensional Fatigue Symptom Inventory Short Form (MFSI-SF) as well as the Hospitality Anxiety and Depression scale (HADS). After controlling for demographic and medical factors, fatigue (p<0.01) but not psychological distress (p>0.05) was negatively associated with physical QoL, explaining 11.0% of the variance. Fatigue (p<0.001) and psychological distress (p<0.001) were significant predictors of mental QoL,explaining an additional 36.2% and 3.6% of the variance. Further analyses revealed that all subscales of the HADS (e.g. anxiety and depression) and of the MFSI-SF (e.g. general fatigue, physical fatigue, emotional fatigue, mental fatigue and vigor) were significant predictors of mental QoL. MFSI-SF subscales also predicted physical QoL. The findings suggest that fatigue and psychological distress substantially predict QoL in patients with a previous venous thromboembolic event above and beyond demographic factors.


2016 ◽  
Vol 33 (S1) ◽  
pp. S500-S501
Author(s):  
M. Domijan ◽  
Z. Lončar ◽  
S. Udovičić

IntroductionAbout 15–20% of the population suffering from the chronic pain. Over time, chronic pain can result in different emotional problems, social isolation, sleep disturbances, which reduce the quality of life. Chronic pain syndrome (CPS) indicates persistent pain, subjective symptoms in excess of objective findings, associated dysfunctional pain behavious and self-limitation in activities of daily living. Duloxetine is a potent antidepressant approved by the Food and Drug Administration for the chronic musculoskeletal disorder, diabetic neuropathic pain, fibromyalgia, generallized anxiety disorder and major depressive disorder.ObjectiveTo determine the effect of duloxetine on the reduction of pain and psychosocial suffering.AimsThe goal of the treatment should be to effectively reduce pain while improving function and reducing psychosocial suffering.MethodsThirty-six adult, nondepressed patients, already on tramadol therapy were included. Patients with VAS (visual analogue scale) ≥ 4were treated with duloxetine for 13 weeks. We measured pain intensity with the McGill Pain Questionnaire-Short Form (MPQ-SF) and compared VAS before starting the treatment with duloxetine and weekly for 13 weeks.ResultsPain response was defined as a 30%decrease in the MPQ-SF. A total of 62.5% of the sample met these criteria for response. Among them, 13.8% of patients were discontinued because of adverse effects. Duloxetine significantly improved functioning and the quality of life in patients with CPS.ConclusionsBecause of it is analgesic properties, duloxetine in the lower antidepressant doses (60 mg taken ones daily) combined with tramadol (another analgesic agent) can be useful in CPS for patients who do not respond satisfactory to monotherapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.


Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 565-573 ◽  
Author(s):  
Joseph T. King ◽  
Joel Tsevat ◽  
Mark S. Roberts

Abstract OBJECTIVE Cerebral aneurysms can adversely affect quality of life (QOL) via mass effect, subarachnoid hemorrhage, anxiety, or treatment sequelae. The EuroQol EQ-5D is a popular generic 5-item multiple-choice survey questionnaire that measures preference-based QOL on a 0 to 1 scale. We assessed the validity and reliability of the EQ-5D in patients with cerebral aneurysms. METHODS We collected data from 178 neurosurgery clinic patients with cerebral aneurysms. Patients were assigned Glasgow Outcome Scale, Rankin scale, Barthel index, and Physical Performance Test scores, and completed the Short-Form 12, Hospital Anxiety and Depression scale, and the EQ-5D. We assessed the construct validity of the EQ-5D by comparing the EQ-5D and the other scales using rank-order methods and multivariate linear regression. Reliability was assessed with Cronbach's α. RESULTS Patients had a mean age of 54.7 years (standard deviation, 12.6 years), 131 (74%) were women, and 98 (55%) had survived a subarachnoid hemorrhage. The mean EQ-5D score was 0.80 (standard deviation, 0.19). Construct validity of the EQ-5D was confirmed by statistically significant associations between EQ-5D and Glasgow Outcome Scale, Rankin scale, Barthel index, Physical Performance Test, Short-Form 12 Physical Component Summary, and Hospital Anxiety and Depression scores (for all, P ≤ 0.05). Multivariate regression showed that the EQ-5D scores were independently associated with the Barthel index, Short-Form 12 Physical Component Summary, and Hospital Anxiety and Depression scale anxiety and depression subscales (pseudo R2 = 0.40). Reliability was demonstrated by Cronbach's α of 0.70. CONCLUSION The EQ-5D is a valid and reliable instrument for measuring QOL in patients with cerebral aneurysms. The EQ-5D provides a single QOL value incorporating functional status, physical functioning, and mental health.


2016 ◽  
Vol 18 (4) ◽  
pp. 192-200 ◽  
Author(s):  
Holly A. Parkerson ◽  
Melissa D. Kehler ◽  
Donald Sharpe ◽  
Heather D. Hadjistavropoulos

Background: The Coping with Multiple Sclerosis Scale (CMSS) was developed to assess coping strategies specific to multiple sclerosis (MS). Despite its wide application in MS research, psychometric support for the CMSS remains limited to the initial factor analytic investigation by Pakenham in 2001. Methods: The current investigation assessed the factor structure and construct validity of the CMSS. Participants with MS (N = 453) completed the CMSS, as well as measures of disability related to MS (Multiple Sclerosis Impact Scale), quality of life (World Health Organization Quality of Life Brief Scale), and anxiety and depression (Hospital Anxiety and Depression Scale). Results: The original factor structure reported by Pakenham was a poor fit to the data. An alternate seven-factor structure was identified using exploratory factor analysis. Although there were some similarities with the existing CMSS subscales, differences in factor content and item loadings were found. Relationships between the revised CMSS subscales and additional measures were assessed, and the findings were consistent with previous research. Conclusions: Refinement of the CMSS is suggested, especially for subscales related to acceptance and avoidance strategies. Until further research is conducted on the revised CMSS, it is recommended that the original CMSS continue to be administered. Clinicians and researchers should be mindful of lack of support for the acceptance and avoidance subscales and should seek additional scales to assess these areas.


2003 ◽  
Vol 9 (4) ◽  
pp. 397-403 ◽  
Author(s):  
A CJW Janssens ◽  
P A van Doorn ◽  
J B de Boer ◽  
N F Kalkers ◽  
F GA van der Meché ◽  
...  

Disability status, depression and anxiety are important determinants of quality of life (Q oL) in patients with multiple sclerosis (MS). We investigated whether anxiety and depression influence the relation between disability status and Q oL in our cohort of recently diagnosed patients. Disability status [Expanded Disability Status Scale (EDSS)], anxiety and depression [Hospital A nxiety and Depression Scale (HADS)], and Q oL (SF-36) were prospectively obtained in 101 MS patients. The relation between EDSS and SF-36 scales was examined using regression analyses, without and with adjustment for anxiety and depression. Interaction effects were investigated by comparing the relation between EDSS and Q oL in patients with high and low anxiety and depression. In the unadjusted analyses, EDSS was significantly related to all SF-36 physical and mental health scales. A fter adjustment for anxiety and depression, EDSS was significantly related only to the SF-36 physical functioning, role-physical functioning and bodily pain scales. The relation between EDSS and these SF-36 scales was consistently higher in patients with more symptoms of anxiety or depression, suggesting that anxiety and depression strengthened the association of EDSS in these SF-36 physical health scales. A fter adjustment for anxiety and depression, EDSS was not significantly related to the SF-36 mental health scales and the general health scale. This finding is compatible with the hypothesis that anxiety and depression are intermediate factors in the association of EDSS with these SF-36 scales. Screening for symptoms of anxiety and depression is recommended in studies that use Q oL as an outcome measure of treatment or intervention efficacy.


2007 ◽  
Vol 157 (2) ◽  
pp. 133-139 ◽  
Author(s):  
M Kars ◽  
A A van der Klaauw ◽  
C S Onstein ◽  
A M Pereira ◽  
J A Romijn

Objective: Most studies on treatment of microprolactinoma have focused on clinical and biochemical outcome rather than on functional and mental well-being. We evaluated this topic in female patients with microprolactinoma, because other pituitary adenomas are associated with decreased quality of life. Design: We conducted a cross-sectional study. Patients and methods: To assess the impact of treatment for microprolactinoma on subjective well-being, quality of life was investigated in 55 female patients (mean age 45 ± 10 years), treated for microprolactinoma in our center, using four validated, health-related questionnaires: Short-Form-36 (SF-36), Nottingham Health Profile (NHP), Multidimensional Fatigue Inventory (MFI-20), and Hospital Anxiety and Depression Scale (HADS). Patient outcomes were compared with those of 183 female controls with equal age distributions. Results: Anxiety and depression scores were increased when compared with controls for all subscales as measured by HADS, and fatigue for all but one subscale as measured by MFI-20. Patients treated for microprolactinoma had worse scores on social functioning, role limitations due to physical problems (SF-36), energy, emotional reaction, and social isolation (NHP) when compared with control subjects. Important independent predictors of quality of life were reproductive status and anxiety and depression scores according to the HADS. Conclusion: Quality of life is impaired in female patients treated for microprolactinoma, especially due to increased anxiety and depression. These increased anxious and depressive feelings might be due to possible effects of hyperprolactinemia on the central nervous system. Failure to recognize this association may adversely affect patient–doctor relationships.


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1583-1583
Author(s):  
Narayanankutty Edavalath Warrier ◽  
Uma V Sankar ◽  
Sreedharan P. S. ◽  
Prasanth V. Parameswaran ◽  
Sajeevan K. V. ◽  
...  

1583 Background: Good mental health improves the overall quality of life. Anxiety and depression in post-treatment cancer survivors is common and can affect adversely on the individual. CanCovDirect is a novel, tele-medicine self-care intervention for cancer survivors. We practiced a randomized controlled superiority trial to compare CanCovDirect with usual standard care (SC) in this population.Methods: Individuals completing cancer treatment within the past 3 years who had symptoms with or without anxiety or depression were recruited from clinical and community settings in Northern Kerala. We allocated the participants using block randomization (CanCovDirect plus SC or to SC alone). Assessments of anxiety and depression severity (Centre for Epidemiological Studies-Depression scale [CES-D]; primary outcome) and secondary outcomes anxiety symptoms (Hospital Anxiety and Depression Scale) health-related quality of life (Short Form Survey-12 mental and physical component summaries), were conducted at baseline, as well as 3 and 6 months (primary time point). Analyses of outcomes were adjusted for covariates using linear regression. Results: Participants recruited between June 2020 and November 2020 were randomly assigned to CanCovDirect (n = 152) or SC (n = 152). Among 350 participants randomly assigned, 304 (86.85%) completed the primary outcome at 6 months. CanCovDirect participants reported less severe anxiety and depressive symptoms on the CES-D than SC participants at 6 months, adjusted effect size (ES) 1.68 (95% CI, 1.28 to 2.05). CanCovDirect participants also had significantly greater quality of life compared with SC. Exploratory analysis suggested that types of cancer was a modifier of the primary outcome (interaction term P value =.04); the intervention was effective in women (ES, 0.62; 95% CI, −0.45 to 0.89). Conclusions: CanCovDirect is an essential method of managing mild-moderate depression and anxiety symptoms in cancer survivors.


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