Pain, cognition and disability in advanced multiple sclerosis

Abstract Objectives In patients with multiple sclerosis (MS), a relationship between physical disability and pain has been observed. In addition a relationship between physical disability and cognition in MS has been suggested. However, cognitive functions and pain appear not to be correlated in MS patients. Therefore, we examined whether a possible relationship between pain and cognitive functioning may exist, and if so, if such a relationship is mediated by physical disability. Methods Forty-five MS patients with chronic pain, and in an advanced stage of the disease were included. Physical disabilities were assessed by the Expanded Disability Status Scale (EDSS). Episodic memory was assessed by means of the Eight Words test, and Face and Picture Recognition. Executive functions (EF) were examined by Digit Span Backward for working memory, and the Rule Shift Cards and Category Fluency test for cognitive flexibility. Pain Intensity and Pain Affect were assessed by means of visual analogue scales and one verbal pain scale and mood (depression, anxiety) by the Beck Depression Inventory and the Symptom Check List (SCL-90). The research questions were analyzed by means of regression analyses and the Sobel test for mediation. Results A significant relationship was found between Pain Affect and EF, but that relationship was not mediated by physical disabilities (EDSS). In addition, Pain Intensity and EF showed a significant relationship but only in combination with physical disabilities (EDSS). Finally, mood was related to pain affect. Discussion The findings suggest that the lower the EF, exclusively or in combination with more physical disabilities, the more the patient may suffer from pain. Implications The more one is cognitively and physically impaired, the more one might suffer from pain, and, the less one is able to communicate pain. The latter could put MS patients at risk for underdiagnosing and undertreatment of pain.

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Using an App to monitor postoperative pain at home in pediatric patients

Journal of Child Health Care ◽

10.1177/1367493520919313 ◽

2021 ◽

pp. 136749352091931

Author(s):

Emanuela Tiozzo ◽

Valentina Biagioli ◽

Matilde Brancaccio ◽

Riccardo Ricci ◽

Anna Marchetti ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Health Professionals ◽

Pediatric Patients ◽

Pain Scale ◽

Factors Associated ◽

Prospective Comparative Study ◽

Paper And Pencil ◽

The Impact ◽

At Home

A prospective comparative study was conducted in 487 pediatric patients (69% male, mean age = 6.4 ± 4.0) to evaluate (a) the incidence, intensity, and characteristics of pain in pediatric patients at home during the first 24 hours and 5 days after surgery and (b) the factors associated with higher pain intensity, including the impact of an application (App) compared to the paper-and-pencil approach. Postoperative pain was assessed by patients or their parents at home using the ‘Bambino Gesù’ Children’s Hospital (Ospedale Pediatrico Bambino Gesù, OPBG) tool for participants aged 4–17 years or the Faces, Legs, Arms, Cry, and Consolability scale for participants less than four years old. Participants were assigned to two groups: those who used the paper-and-pencil version of the pain scale and those who used the App. Overall, 209 of the 472 (44%) participants reported pain during the first 24 hours, and 92 of the 420 (22%) reported pain between one and five days after surgery. Higher pain intensity scores were associated with being in the App group, directly assessing own pain, and using the OPBG tool. The App was effective in facilitating pain assessment. Health professionals could empower pediatric patients and their parents in assessing pain at home through a dedicated App.

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Voxelwise analysis of conventional magnetic resonance imaging to predict future disability in early relapsing–remitting multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458512442991 ◽

2012 ◽

Vol 18 (11) ◽

pp. 1585-1591 ◽

Cited By ~ 9

Author(s):

Delphine Wybrecht ◽

Françoise Reuter ◽

Wafaa Zaaraoui ◽

Anthony Faivre ◽

Lydie Crespy ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Magnetic Resonance ◽

Physical Disability ◽

Conventional Magnetic Resonance Imaging ◽

Global Approach ◽

Resonance Imaging ◽

Conventional Magnetic Resonance ◽

Magnetic Resonance Imaging Mri ◽

Mri Changes

Background: The ability of conventional magnetic resonance imaging (MRI) to predict subsequent physical disability and cognitive deterioration after a clinically isolated syndrome (CIS) is weak. Objectives: We aimed to investigate whether conventional MRI changes over 1 year could predict cognitive and physical disability 5 years later in CIS. We performed analyses using a global approach (T2 lesion load, number of T2 lesions), but also a topographic approach. Methods: This study included 38 patients with a CIS. At inclusion, 10 out of 38 patients fulfilled the 2010 revised McDonald’s criteria for the diagnosis of multiple sclerosis. Expanded Disability Status Scale (EDSS) evaluation was performed at baseline, year 1 and year 5, and cognitive evaluation at baseline and year 5. T2-weighted MRI was performed at baseline and year 1. We used voxelwise analysis to analyse the predictive value of lesions location for subsequent disability. Results: Using the global approach, no correlation was found between MRI and clinical data. The occurrence or growth of new lesions in the brainstem was correlated with EDSS changes over the 5 years of follow-up. The occurrence or growth of new lesions in cerebellum, thalami, corpus callosum and frontal lobes over 1 year was correlated with cognitive impairment at 5 years. Conclusion: The assessment of lesion location at the first stage of multiple sclerosis may be of value to predict future clinical disability.

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A-67Cognition, Depression, and Physical Disability in Multiple Sclerosis as Predictors of Illness Intrusiveness

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acx076.67 ◽

2017 ◽

Vol 32 (6) ◽

pp. 667-765

Author(s):

J Portnoy ◽

C Altaras ◽

J Miller ◽

F Foley

Keyword(s):

Multiple Sclerosis ◽

Physical Disability ◽

Illness Intrusiveness

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CORRELATION BETWEEN WONG-BAKER FACES PAIN SCALE AND SALIVARY ALPHA-AMYLASE LEVEL IN CHILDREN AGED 6–11 YEARS

International Journal of Applied Pharmaceutics ◽

10.22159/ijap.2017.v9s2.34 ◽

2018 ◽

Vol 9 ◽

pp. 133

Author(s):

Hastin Dian Anggraeni ◽

Margaretha Suharsini ◽

Ike Siti Indiarti ◽

Faraghea Yumasdhika

Keyword(s):

Pain Intensity ◽

Local Anesthetic ◽

Extraction Procedure ◽

Pain Scale ◽

Alpha Amylase ◽

Primary Tooth ◽

Amylase Level ◽

Salivary Alpha Amylase ◽

Local Anesthetic Injection ◽

Spearman’S Correlation

Objective: Several studies have tried to objectively assess pain measurements. The Wong-Baker Faces Pain Scale (WBFPS) is an instrument that is commonly used to assess pain intensity in children. This study aimed to analyze the correlation between the WBFPS and salivary alpha-amylase (SAA) level during a tooth extraction procedure with a local anesthetic injection in children aged 6–11 years.Methods: Twenty-five children aged 6–11 years who were to undergo the extraction of a primary tooth at the Dental and Oral Educational Hospital, Faculty of Dentistry Universitas Indonesia, were enrolled in this study. From all children, saliva was collected using a disposable saliva strip shortly after local anesthetic injection, and the SAA activity was then determined using a portable Nipro Cocoro Meter device. The WBFPS was measured at the same time. The correlation between the WBFPS and the SAA level was analyzed using Spearman’s correlation test. The statistically significant level was set at p≤0.05.Results: There was a significant correlation between the WBFPS and SAA level (p=0.002, r=0.581).Conclusion: Our data suggest that the SAA level might be a good index for objective pain intensity assessment.

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Qualitative and quantitative aspects of pain in lateral posterior thoracotomy patients

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692006000500011 ◽

2006 ◽

Vol 14 (5) ◽

pp. 708-712 ◽

Cited By ~ 3

Author(s):

Thaiza Teixeira Xavier ◽

Gilson de Vasconcelos Torres ◽

Vera Maria da Rocha

Keyword(s):

Pain Intensity ◽

Statistical Difference ◽

Descriptive Study ◽

Pain Scale ◽

Study Group ◽

Men And Women ◽

Evaluation Form ◽

Qualitative And Quantitative ◽

Significant Statistical Difference ◽

Lateral Posterior

Descriptive study that proposed to compare the qualitative and quantitative behavior of the pain in lateral posterior thoracotomy patients. The sample was consisted of 18 individuals with an average age of 44 years. The instruments used were physiotherapy evaluation form, numerical pain scale and McGill questionnaire for pain. The pain on the numerical pain scale was considered moderate(5) for both sexes. The descriptors of the McGill questionnaire choosen by the patients with higher frequency were: in the sensorial component, beat4, pointed1, shock2, final and pull2; in the afetive component, tired1, bored1, punishald1 and miserable1 and in the evaluative component was flat. The characteristics of pain in the sensorial group were more evidents on male group. No significant statistical difeferences were observed between quantitative answers concerning pain between the men and women. On the qualitative aspects , was observed an predominancy of the same descriptors of pain in afetive component for both sexes. Pain intensity was categorized as moderate. No significant statistical difference were observed between the pain on the post-operatory lateral posterior thoracotomy. These data demonstrate a necessity for an analysis with a larger study group.

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Risk factors for physical disability in patients with leprosy disease in Yunnan, China: Evidence from a retrospective observational study

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009923 ◽

2021 ◽

Vol 15 (11) ◽

pp. e0009923

Author(s):

Xiaohua Chen ◽

Hong-bing Liu ◽

Tie-Jun Shui ◽

Shun Zha

Keyword(s):

Risk Factors ◽

Physical Disability ◽

Physical Disabilities ◽

Delayed Diagnosis ◽

Skin Lesions ◽

Nerve Damage ◽

Advanced Age ◽

Han Ethnicity ◽

Leprosy Patients ◽

Male Sex

Background Leprosy is potentially debilitating. The risk factors related to physical disabilities associated with leprosy disease in Yunnan, China was not clear. Methodology/Principal findings We studied 10644 newly detected leprosy patients from Yunnan, China, from 1990 to 2019. Factors associated with Grade 1 (G1D) and Grade 2 (G2D) physical disabilities or overall physical disabilities (combined G1D and G2D) associated with leprosy were analyzed using multinomial and ordinal logistic regression analyses. The following factors were associated with the development of physical disability in these patients with leprosy: delayed diagnosis [odds ratio (OR): 5.652, 4.399, and 2.275; 95% confidence intervals (CIs): 4.516–7.073, 3.714–5.212, and 2.063–2.509; for ≥ 10, 5–10 y, and 2–5 years, respectively], nerve damage (OR: 3.474 and 2.428; 95% CI: 2.843–4.244, and 1.959–3.008; for 2 and 1 damaged nerves, respectively), WHO classification of PB (OR: 1.759; 95% CI: 1.341–2.307), Ridley-Jopling classification (OR: 1.479, 1.438, 1.522 and 1.239; 95% CI: 1.052–2.079, 1.075–1.923, 1.261–1.838, and 1.072–1.431; for TT, BT, BB, and BL when compared with LL, respectively), advanced age (OR: 1.472 and 2.053; 95% CI: 1.106–1.960 and 1.498–2.814; for 15–59 and over 60 years old, respectively), zero skin lesions (OR: 1.916; 95% CI: 1.522–2.413), leprosy reaction (OR: 1.528; 95% CI: 1.195–1.952), rural occupation (OR: 1.364; 95% CI: 1.128–1.650), Han ethnicity (OR: 1.268; 95% CI: 1.159–1.386), and male sex (OR: 1.128; 95% CI: 1.024–1.243). Conclusions Delayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.

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Relationship between Physical Disability and Black Holes in Multiple Sclerosis: Upper Extremity Functions - an Important Parameter

10.4274/jmsr.galenos.2021.6-2 ◽

2021 ◽

Vol 1 (1) ◽

pp. 17-21

Author(s):

Bilge Piri Cinar ◽

Gülcan Kalaycı ◽

Mustafa Acikgoz ◽

Serkan Ozakbas

Keyword(s):

Multiple Sclerosis ◽

Black Holes ◽

Upper Extremity ◽

Physical Disability

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Pre-existing anxiety, depression, and neurological disability are associated with long COVID: A prospective and longitudinal cohort study of the United Kingdom Multiple Sclerosis Register

10.1101/2021.06.25.21259256 ◽

2021 ◽

Author(s):

Afagh Garjani ◽

Rodden M Middleton ◽

Richard Nicholas ◽

Nikos Evangelou

Keyword(s):

Multiple Sclerosis ◽

United Kingdom ◽

Physical Disability ◽

Mental Health Problems ◽

Cox Regression ◽

Depression Scale ◽

Symptom Duration ◽

Cox Regression Analysis ◽

The United Kingdom ◽

Recovery Status

Objectives: To assess the prevalence of and factors associated with developing long COVID among patients with multiple sclerosis (MS), a condition which shares the neurological and psychological symptomatology of long COVID Design: Community-based prospective and longitudinal observational study Setting: The United Kingdom (UK) MS Register (UKMSR) COVID-19 study Participants: A national cohort of MS patients with COVID-19 Main outcome measures: Participants used the online questionnaire-based platform of the UKMSR to update their COVID-19 symptoms and recovery status. Questionnaires were date-stamped for estimation of COVID-19 symptom duration. The UKMSR also holds demographic and up-to-date clinical data on participants including comorbidities, MS type, date of MS diagnosis, disease-modifying therapies, web-based Expanded Disability Status Scale scores (a measure of physical disability in MS), and Hospital Anxiety and Depression Scale. The association between these factors and recovery from COVID-19 was assessed using multivariable Cox regression analysis. Results: Out of 7,977 MS patients who participated in the UKMSR COVID-19 study, 599 had COVID-19 and updated their recovery status prospectively. At least 181 participants (31.1%) had long-standing COVID-19 symptoms for ≥4 weeks and 76 (13.1 %) for ≥12 weeks. Participants with higher levels of pre-COVID-19 physical disability, participants with anxiety and/or depression prior to COVID-19 onset, and women were less likely to recover from COVID-19. Conclusions: Long COVID appears to affect patients with a pre-existing chronic condition, especially those with physical disabilities or mental health problems disproportionately when compared to reports in the general population. Long COVID research and the development of post-COVID-19 rehabilitation services need to be inclusive of these at-risk populations. Trial Registration: ClinicalTrials.gov: NCT04354519

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Early predictors of multiple sclerosis after a typical clinically isolated syndrome

Multiple Sclerosis Journal ◽

10.1177/1352458514533397 ◽

2014 ◽

Vol 20 (13) ◽

pp. 1721-1726 ◽

Cited By ~ 24

Author(s):

Aurélie Ruet ◽

Georgina Arrambide ◽

Bruno Brochet ◽

Cristina Auger ◽

Eva Simon ◽

...

Keyword(s):

Multiple Sclerosis ◽

At Risk ◽

High Specificity ◽

Clinically Isolated Syndrome ◽

Oligoclonal Bands ◽

Mcdonald Criteria ◽

Early Predictors ◽

Patients At Risk ◽

Magnetic Resonance Imaging Mri ◽

Periventricular Lesions

Background: The 2010 McDonald criteria allow diagnosing multiple sclerosis (MS) with one magnetic resonance imaging (MRI) scan. Nevertheless, not all patients at risk fulfil criteria at baseline. Other predictive factors (PFs) are: age ≤40 years, positive oligoclonal bands (OBs), and ≥3 periventricular lesions. Objective: The purpose of this study was to evaluate the 2010 McDonald criteria performance and to assess other PFs in patients without dissemination in space (DIS). Methods: Patients with clinically isolated syndrome (CIS) underwent baseline MRI and OB determination with clinical and radiological follow-up. Adjusted hazard ratios (aHRs) for clinically definite MS were estimated for DIS, dissemination in time (DIT), and DIS+DIT. Diagnostic properties at two years were calculated. In cases without DIS, combinations of ≥2 PFs were assessed. Results: A total of 652 patients were recruited; aHRs were 3.8 (2.5–5.8) for DIS, 4.2 (1.9–9.2) for DIT, and 8.6 (5.4–13.8) for DIS+DIT. Sensitivities were 69.6%, 42.3%, and 36.4%, and specificities were 67.3%, 87.9%, and 90.2%, respectively. In patients without DIS, aHRs varied between 2.7–5.5 and specificities ranged from 73.5–89.7% for PF combinations. Conclusion: The high specificity of the 2010 McDonald criteria is confirmed. In patients without DIS, PF combinations could be helpful in identifying those at risk for MS.

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