A clear association was seen between the substantial pain that multiple sclerosis (MS) patients experience and lifestyle choices that either augment or ease that pain, like smoking habits, exercise, and diet and weight, researchers in Australia report.
Common co-morbidities associated with MS, such as depression, anxiety, and fatigue, were also seen to hamper efforts to start or maintain healthy behaviors.
The study, “Pain in People with Multiple Sclerosis: Associations with Modifiable Lifestyle Factors, Fatigue, Depression, Anxiety, and Mental Health Quality of Life,” and was published in the journal Frontiers in Neurology.
Led by researchers at the University of Melbourne, the work aimed to determine associations between moderate-to-severe pain caused by MS — including headaches, lower back pain, neuropathic pain and painful spasms — and lifestyle and co-morbidity factors that impact the disease in a large international cohort of patients.
The team recruited online 2,362 participants, age 18 and older, with a confirmed MS diagnosis. Participants were from all over the world, but in greater concentrations from English-speaking countries. The online survey collected 2012 data from patients, and the team used statistic tools to analyze the information gathered.
Researchers found that more than a fourth of the participants (28.9%) reported moderate to severe pain that interfered with work, household or enjoyment of life in the four weeks prior to the survey.
Some findings were in agreement with previous studies. One was that poorer diet, such as a high-fat diet, together with obesity were two of the most important factors linked with substantial pain in MS. These patients reported twice as high a likelihood of substantial pain than did those with better diet choices and with normal weight, as determined by body mass index or BMI.
In addition, smokers were twice as likely to report substantial pain than patients who did not smoke.
Participants who exercised moderately reported 1.4 to 1.5 times lower substantial pain when compared with patients who exercised less. Those who engaged in more active and intense physical activity were also 1.7 times less likely to report substantial pain.
In agreement with other studies, the team also found that the disability level, reduced mental health quality of life, fatigue, depression, and anxiety are strongly related to substantial pain in MS patients.
The team highlighted that pain caused by the central nervous system demyelination and degeneration in MS also contributes to depression, anxiety, and fatigue. This, in turn, can promote a “positive feedback loop” whereby pain exacerbates poorer lifestyle behaviors — such as smoking and physical inactivity — that are maintained due to the presence of pain.
“For the first time, we showed that tobacco smoking, obesity, lack of exercise, and poor diet were also associated with pain,” the researchers wrote. “These factors are already considered in the prevention and management of pain in other populations but have not previously been considered in MS.”
And, the study concluded, treatment strategies that address these factors need to be considered. “Further research is needed to disentangle the complex interplay between these lifestyle factors, symptoms, and comorbidities, which may contribute to pain, or may be caused or maintained by the presence of pain,” the researchers wrote.