Pain, cognition and disability in advanced multiple sclerosis
Author:
Scherder Rogier J.1, Prins Angela J.2, van Dorp Marit J.3, van Klaveren Chris4, Cornelisz Ilja4, Killestein Joep5, Weinstein Henry6
Affiliation:
1. Medical Faculty, Vrije Universiteit , Van der Boechorststraat 7 , 1081 BT Amsterdam , The Netherlands 2. Atlant , Beekbergen , The Netherlands 3. Tante Louise , Bergen op Zoom , The Netherlands 4. Department of Clinical Neuropsychology , Vrije Universiteit , Amsterdam , The Netherlands 5. Department of Neurology , Amsterdam UMC location VUmc , Amsterdam , The Netherlands 6. Department of Neurology , OLVG location West , Amsterdam , The Netherlands
Abstract
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.
Publisher
Walter de Gruyter GmbH
Subject
Anesthesiology and Pain Medicine,Neurology (clinical)
Reference64 articles.
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