High levels of pain and fatigue in MS Patients with co morbidities

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High levels of pain and fatigue in MS Patients with co morbidities

The new study finds that disabling pain and moderate to severe fatigue is more expected to be reported by patients with multiple sclerosis (MS), with co morbidities, like fibromyalgia and irritable bowel syndrome (IBS).

According to the researchers, co morbidities influence quality of life and management of MS. Current data shows an increased occurrence of fatigue and pain in MS though much is not known about the relationship between co morbidities and these symptoms. With an intention to find the link between co morbidity, pain and fatigue, 949 people with definite MS were enrolled by the investigators. The patients were seen in four outpatient MS clinics in Canada, between July 2010 and March 2011.

According to the study author Kirsten Fiest, PhD, postdoctoral fellow, University of Manitoba, Winnipeg, understanding the relationship between pain, fatigue and co morbidity can regulate better management of disabling symptoms in persons with MS. Patients completed co morbidity questionnaire and fatigue impact scale and health utilities index for identifying patients with/without pain that impairs daily life, were also used. The presence of severity of pain, fatigue and current status of these symptoms were examined during two follow-up consecutive annual clinic visits. Depression (29%), hypertension (17.8%), migraine (17.3%), high cholesterol (12.4%), anxiety (11.5%), chronic obstructive pulmonary disease (COPD; 9.8%) and IBS (7.9%) were the main co morbidities at baseline.

The patients with fibromyalgia as co morbidity were 3.74 times more prone to develop disruptive pain and patient without fibromyalgia were 2.75 times more expected to report fatigue. Patients with IBS were 2.21 and 1.7 times more likely to report disabling pain and fatigue than people without IBS as co morbidity.

Fatigue and pain were present in 53.4% (n=507) and 40.4% (n=383) patients at baseline and at one-year follow-up, 32.7% of patients who did not have pain at baseline had incident pain and overall, 59.9% of patients had pain by the end of first year. By the second year, 35.2% of patients without pain at baseline or first year, had incident pain and overall 78.3% of patients had pain. The rates of incident fatigue at one- and two-year follow-ups were 28.9% and 29.9% and overall 66.87% of patients had fatigue by the end of first year and 76.78% had fatigue by the end of 2 years.

Patients with co morbid fibromyalgia had greatest odds of having disabling pain and moderate to severe fatigue between baseline and 2 year follow-up (odds ratio [OR], 3.74 and 2.74, respectively). The ORs for co morbid IBS were 2.21 and 1.70 and were 1.58 and 2.68 for co morbid depression. Anxiety, COPD and autoimmune thyroid disease were also linked with considerably increased odds for disabling pain and moderate to severe fatigue over time. ORs for incident pain for 1st and 2nd years among patients with various co morbidities was not calculated by the investigators due to small subgroup sizes without pain at baseline.

Erik Charlson, MD, fellow in MS, New York University, Langone Medical Center, New York City believes that having pain management physicians be aware that other diseases that are potentially treatable seem to associate with pain in the multiple sclerosis population is important. He also said that these results fit a lot of the patients seen in his MS clinic and also it is difficult to treat so many issues as the patients may have pain and depression, another neurologic condition or other difficult-to-manage problems.

Clinical pain medicine.
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