TY - JOUR
T1 - Pain, cognition and disability in advanced multiple sclerosis
AU - Scherder, Rogier J.
AU - Prins, Angela J.
AU - van Dorp, Marit J.
AU - van Klaveren, Chris
AU - Cornelisz, Ilja
AU - Killestein, Joep
AU - Weinstein, Henry
N1 - Publisher Copyright: © 2021 Walter de Gruyter GmbH, Berlin/Boston. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - 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.
AB - 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.
KW - anxiety
KW - chronic pain
KW - depression
KW - executive functions
KW - mood
KW - multiple sclerosis
KW - physical disability
KW - regression analyses
KW - visual analogue scales
KW - working memory
UR - http://www.scopus.com/inward/record.url?scp=85115651810&partnerID=8YFLogxK
U2 - https://doi.org/10.1515/sjpain-2021-0067
DO - https://doi.org/10.1515/sjpain-2021-0067
M3 - Article
C2 - 34469640
SN - 1877-8860
VL - 21
SP - 754
EP - 765
JO - SCANDINAVIAN JOURNAL OF PAIN
JF - SCANDINAVIAN JOURNAL OF PAIN
IS - 4
ER -