The influence of intensity and neuropathic component of pain syndrome on the quality of life in patients with multiple sclerosis

Authors

DOI:

https://doi.org/10.14739/2310-1210.2021.5.206017

Keywords:

multiple sclerosis, pain, pain syndromes, pain intensity, neuropathic pain, nociceptive pain, quality of life

Abstract

The aim of the work. To analyze the influence of intensity and neuropathic component of pain syndrome on the quality of life structure characteristics in patients with multiple sclerosis (MS).

Materials and methods. 104 MS patients with different types of MS course and complaints of pain during the last month were examined in the Lviv Regional Multiple Sclerosis Center. The patients were interviewed using standardized questionnaires (Pain Detect, VAS, SF-36) followed by an analysis of the pain characteristics influence on the quality of life.

Results. When assessing the influence of the main characteristics of MS course, the relationship between the physical component of quality of life and levels of disability (EDSS) and the total number of relapses was found (r = -0.60, P < 0.01; r = -0.34, P < 0.01, respectively). However, the mental component of quality of life had no significant relationship with the level of disability and the number of relapses. The average pain intensity within a month on the VAS scale was 5.0 [4.0; 7.0]. 24.0 % of patients had low-intensity pain, 54.8 % – moderate, 21.2 % – high. In MS patients with low-intensity pain within a month, 5 of the 11 quality of life indicators were significantly higher, in particular, the overall physical component of quality of life – 38.1 [33.8; 48.5] % in low-intensity pain against 31.8 [28.1; 38.7] %, P = 0.02 – in moderate. In MS patients, the level of both physical (r = -0.25; P = 0.01) and mental (r = -0.21; P = 0.03) component of quality of life decreased with increasing pain intensity. The most notable correlation was observed between intensity of pain and such characteristics of quality of life as energy/fatigue (r = -0.37; P ˂ 0.01) and emotional well-being (r = -0.28; P ˂ 0.01). In 30.8 % of patients, pain was neuropathic, in 47.1 % – nociceptive, in 22.1 % – undetermined. MS patients with the neuropathic type of pain had significantly lower scores, 7 out of 11 indicators of quality of life, largely the mental component, than scores in MS patients with nociceptive type (Р < 0.05). Correlation analysis showed the association between an increase in the manifestation of neuropathic pain component and a decrease in all quality of life characteristics, except in health change. In MS patients with a neuropathic component, in increasing level of its manifestation, the mental component of health decreased clearly (r = -0.36; P ˂ 0.01), namely its social functioning characteristic (r = -0.35; P < 0.01).

Conclusions. In MS patients, increasing intensity of pain decreases both physical and mental components of quality of life with the most significant decrease in energy/fatigue and emotional well-being as parts of the mental component of quality of life. The neuropathic component of pain and the level of its manifestation are largely associated with a decrease in the mental component of quality of life as the overall indicator and social functioning as its structural element.

Author Biographies

T. I. Nehrych, Danylo Halytsky Lviv National Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Neurology

N. L. Bozhenko, Danylo Halytsky Lviv National Medical University, Ukraine

MD, PhD, Associated Professor of the Department of Neurology

M. I. Bozhenko, Danylo Halytsky Lviv National Medical University, Ukraine

MD, MsC (Master of Psychology of Management and Business), Assistant of the Department of Neurology

References

Berkowitz, A. L. (2014). Neurology education in resource-limited settings. Neurology, 82(16), 1463-1464. https://doi.org/10.1212/WNL.0000000000000338

Nehrych, N. O., Nehrych, T. I., Myronovskyi, S. L., Shorobura, M. S., Nehrych, O. I., Kit, Yu. Ya., & Stoika, R. S. (2018). Blood serum 48 kDa form of unconventional myosin 1c characterizes the early stage of multiple sclerosis. Zaporozhye medical journal, 20(4), 538-542. https://doi.org/10.14739/2310-1210.2018.4.135589

Kobelt, G., Eriksson, J., Phillips, G., & Berg, J. (2017). The burden of multiple sclerosis 2015: Methods of data collection, assessment and analysis of costs, quality of life and symptoms. Multiple Sclerosis Journal, 23(Suppl. 2), 4-16. https://doi.org/10.1177/1352458517708097

Karamyan, A., & Sellner, J. (2016). Journal Club: Effect of comorbidity on mortality in multiple sclerosis. Neurology, 86(22), e228-e230. https://doi.org/10.1212/WNL.0000000000002718

Marrie, R. A., Elliott, L., Marriott, J., Cossoy, M., Blanchard, J., Leung, S., & Yu, N. (2015). Effect of comorbidity on mortality in multiple sclerosis. Neurology, 85(3), 240-247. https://doi.org/10.1212/WNL.0000000000001718

Barin, L., Salmen, A., Disanto, G., Babačić, H., Calabrese, P., Chan, A., Kamm, C. P., Kesselring, J., Kuhle, J., Gobbi, C., Pot, C., Puhan, M. A., von Wyl, V., & Swiss Multiple Sclerosis Registry (SMSR). (2018). The disease burden of Multiple Sclerosis from the individual and population perspective: Which symptoms matter most? Multiple Sclerosis and Related Disorders, 25, 112-121. https://doi.org/10.1016/j.msard.2018.07.013

Foley, P. L., Vesterinen, H. M., Laird, B. J., Sena, E. S., Colvin, L. A., Chandran, S., MacLeod, M. R., & Fallon, M. T. (2013). Prevalence and natural history of pain in adults with multiple sclerosis: Systematic review and meta-analysis. Pain, 154(5), 632-642. https://doi.org/10.1016/j.pain.2012.12.002

Solaro, C., Trabucco, E., & Messmer Uccelli, M. (2013). Pain and Multiple Sclerosis: Pathophysiology and Treatment. Current Neurology and Neuroscience Reports, 13(1), Article 320. https://doi.org/10.1007/s11910-012-0320-5

Grau-López, L., Sierra, S., Martínez-Cáceres, E., & Ramo-Tello, C. (2011). Análisis del dolor en pacientes con esclerosis múltiple. Neurología, 26(4), 208-213. https://doi.org/10.1016/j.nrl.2010.07.014

Nehrych, O. I., Pyrohova, V. I., Portnoy, J. G., Stimmel, M., Foley, F. W., & Nehrych, T. I. (2019). The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19: validation and adaptation for Ukrainian population. Mizhnarodnyi nevrolohichnyi zhurnal, (5), 19-25. https://doi.org/10.22141/2224-0713.5.107.2019.176702

Janssens, A. C., van Doorn, P. A., de Boer, J. B., Kalkers, N. F., van der Meche, F. G., Passchier, J., & Hintzen, R. Q. (2003). A nxiety and depression influence the relation between disability status and quality of life in multiple sclerosis. Multiple Sclerosis Journal, 9(4), 397-403. https://doi.org/10.1191/1352458503ms930oa

Schmidt, S., & Jöstingmeyer, P. (2019). Depression, fatigue and disability are independently associated with quality of life in patients with multiple Sclerosis: Results of a cross-sectional study. Multiple Sclerosis and Related Disorders, 35, 262-269. https://doi.org/10.1016/j.msard.2019.07.029

Kratz, A. L., Braley, T. J., Foxen-Craft, E., Scott, E., Murphy, J. F., 3rd, & Murphy, S. L. (2017). How Do Pain, Fatigue, Depressive, and Cognitive Symptoms Relate to Well-Being and Social and Physical Functioning in the Daily Lives of Individuals With Multiple Sclerosis? Archives of Physical Medicine and Rehabilitation, 98(11), 2160-2166. https://doi.org/10.1016/j.apmr.2017.07.004

Łabuz-Roszak, B., Niewiadomska, E., Kubicka-Bączyk, K., Skrzypek, M., Tyrpień-Golder, K., Majewska, A., Matejczyk, A., Dobrakowski, P., & Pierzchała, K. (2019). Występowanie bólu u chorych na stwardnienie rozsiane i jego związek z objawami depresyjnymi, lękiem i jakością życia. Psychiatria Polska, 53(2), 475-486. https://doi.org/10.12740/PP/94469

Brochet, B., Deloire, M. S., Ouallet, J. C., Salort, E., Bonnet, M., Jové, J., & Petry, K. G. (2009). Pain and quality of life in the early stages after multiple sclerosis diagnosis: A 2-year longitudinal study. The Clinical Journal of Pain, 25(3), 211-217. https://doi.org/10.1097/AJP.0b013e3181891347

Marck, C. H., De Livera, A. M., Weiland, T. J., Jelinek, P. L., Neate, S. L., Brown, C. R., Taylor, K. L., Khan, F., & Jelinek, G. A. (2017). Pain in People with Multiple Sclerosis: Associations with Modifiable Lifestyle Factors, Fatigue, Depression, Anxiety, and Mental Health Quality of Life. Frontiers in Neurology, 8, Article 461. https://doi.org/10.3389/fneur.2017.00461

Heitmann, H., Haller, B., Tiemann, L., Mühlau, M., Berthele, A., Tölle, T. R., Salmen, A., Ambrosius, B., Bayas, A., Asseyer, S., Hartung, H. P., Heesen, C., Stangel, M., Wildemann, B., Haars, S., Groppa, S., Luessi, F., Kümpfel, T., Nischwitz, S., Meuth, S. G., … German Competence Network Multiple Sclerosis (KKNMS). (2020). Longitudinal prevalence and determinants of pain in multiple sclerosis: results from the German National Multiple Sclerosis Cohort study. Pain, 161(4), 787-796. https://doi.org/10.1097/j.pain.0000000000001767

WHOQOL Group. (1993). Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Quality of Life Research, 2(2), 153-159. https://doi.org/10.1007/bf00435734

Kalia, L. V., & O'Connor, P. W. (2005). Severity of chronic pain and its relationship to quality of life in multiple sclerosis. Multiple Sclerosis Journal, 11(3), 322-327. https://doi.org/10.1191/1352458505ms1168oa

Veličkaitė, G., Jucevičiūtė, N., Balnytė, R., Laucius, O., & Vaitkus, A. (2020). Pain Characteristics and Associations with Quality of Life in Patients with Multiple Sclerosis in Lithuania. Medicina, 56(11), Article 596. https://doi.org/10.3390/medicina56110596

Published

2021-09-01

How to Cite

1.
Nehrych TI, Bozhenko NL, Bozhenko MI. The influence of intensity and neuropathic component of pain syndrome on the quality of life in patients with multiple sclerosis. Zaporozhye Medical Journal [Internet]. 2021Sep.1 [cited 2024Jul.21];23(5):628-35. Available from: http://zmj.zsmu.edu.ua/article/view/206017

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Section

Original research