Targeting Depression May Help Improve Psychosocial Symptoms in MS

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Treatment Overview
The results suggest that addressing depression may help improve other symptoms, like pain and fatigue.

Interventions targeted towards improving coping skills and social support may help patients with multiple sclerosis (MS) better manage pain, according to research published in the Clinical Journal of Pain.

Pain is a persistent problem in MS, affecting 50% to 60% of individuals. Worse, pain in MS often contributes to other conditions, including depression, fatigue, and sleep disturbances.

In order to examine the associations between pain, MS symptoms, depression, and psychosocial and functional variables, and to identify possible risk or preventive factors, researchers from the University of Queensland in Brisbane, Australia, and colleagues administered a cross-sectional survey to 424 individuals with MS.

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The participants (92% white) were mostly middle-age females (mean = 50.7 years; 80% female) with a duration of MS ranging from less than 1 year to 53 years. MS symptoms were reported based on a 16-item scale, while pain severity was assessed with numerical ranking of 5 items, and pain interference with 4 items. Depressive symptoms were evaluated based on the Center for Epidemiological Studies Depression Scale (CES-D) and Patient Health Questionnaire (PHQ-9), and fatigue was measured using the Fatigue Severity Scale (FSS) and Global Fatigue Index of the Multidimensional Assessment of Fatigue (MAF). Sleep quality was assessed with the Women’s Health Initiative Insomnia Rating Scale (WHIIRS) and the Medical Outcomes Survey (MOSSAD).

Pain severity and depression accounted for more than 50% of variance in pain interference. While pain did not significantly contribute to fatigue and sleep quality, depression and MS symptoms predicted 49% of variance in fatigue, and depression accounted for much of the 40% of predicted variance in sleep quality. Risk factors for pain were low educational attainment and a lack of a committed or marital relationship. This remained even after controlling for diagnostic and demographic variables.

“… pain interference has been described not only as a indicant of physical functioning but also as a core component of health-related quality of life,” the authors wrote. “Therefore, pain interference represents an important domain that should be a central target for psychosocial pain treatments.”

“While pain was significantly associated with sleep quality, depression again emerged as the most substantial predictor,” they continued. “Thus, although pain, diagnostic factors, MS symptoms, and depression are all closely interrelated, given how predominantly depression predicted outcomes in the multivariate model it may be that targeting depression in MS is key to substantially improving multiple critical domains of psychosocial functioning.”


Day MA, Ehde DM, Ward LC, et al. An empirical investigation of a biopsychosocial model of pain in multiple sclerosis. Clin J Pain. 2015; doi: 10.1097/AJP.0000000000000240.