Reducing depressive symptoms early may result in better improvements in functional impairment related to fatigue and pain in patients with multiple sclerosis (MS), according to study results published in the Annals of Behavioral Medicine.

Depression, fatigue, and pain often co-occur in patients with MS, suggesting a potential association between these symptoms. Study researchers sought to determine if early improvements in depression, fatigue impact, or pain interference in patients with MS were linked to improvements in the other 2.

This study was a secondary analysis (ClinicalTrials.gov Identifier: NCT00944190) of a randomized controlled trial of 154 community-dwelling adults with MS and chronic pain, chronic fatigue, and/or moderate depressive symptoms (mean age, 52.59 years). These participants were randomly assigned to either a self-management intervention based upon cognitive behavioral therapy (n=69) or an educational intervention (n=85) for 8 weeks.


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Both interventions were combined in this secondary analysis. Outcomes included depressive symptoms measured by the PHQ-9, fatigue impact measured by the Modified Fatigue Impact Scale, and pain interference measured by the Brief Pain Inventory. The study researchers employed a path analysis that examined associations between pre- to mid-intervention improvement in 1 symptom and pre- to post-improvement in the other 2 symptoms.

There was a statistically significant association between pre- to mid-treatment reduction in depressive symptom severity and pre- to post-treatment reductions in fatigue impact (P <.001) and pain interference (P =.01). Additionally, pre- to mid-treatment reductions in fatigue impact was significantly associated to with pre- to post-treatment reduction in depressive symptom severity (P =.04) but not with pre- to post-treatment reduction in pain interference (P =.12). There was no association between pre- to mid-treatment reductions in pain interference and pre- to post-treatment reductions in depression (P =.11) or fatigue impact (P =.11).

Limitations of the study included its exploratory nature and the inclusion of mostly female (86.4%) and non-Hispanic (84.4%) participants.

The study researchers concluded that future investigations should “examine whether and how targeting depressive symptoms earlier in multisymptom intervention for persons with MS decreases fatigue and pain interference as well as depressive symptoms.”

Reference

Knowles LM, Arewasikporn A, Kratz AL, Turner AP, Alschuler KN, Ehde DM. Early treatment improvements in depression are associated with overall improvements in fatigue impact and pain interference in adults with multiple sclerosis. Ann Behav Med. Published online November 16, 2020. doi:10.1093/abm/kaaa102