Pain and Disturbed Sleep May Be Earliest Symptoms of MS, Study Suggests

Symptoms including sleep disorders and pain may precede by as many as five years the onset of the more well-known symptoms of multiple sclerosis (MS), a study suggests.

Understanding these first symptoms could aid in an early diagnosis, allowing treatment to begin at initial stages of disease.

The study, “Fatigue, Sleep Disorders, Anaemia and Pain in the Multiple Sclerosis Prodrome,” was published in the Multiple Sclerosis Journal.

Some neurological diseases have a prodrome, or suite of symptoms that can emerge before the disorder’s more classical symptoms.

In recent years, emerging evidence has suggested a prodrome for MS, with early symptoms that include migraine, mood disorders, and fibromyalgia. Given the relative infancy of this field, symptoms that could potentially constitute the MS prodrome are still being defined.

Researchers at the University of British Columbia in Canada examined whether four specific symptoms — fatigue, sleep disorders, anemia, and pain — could be part of the MS prodrome based on their presence in the five years preceding an MS clinical diagnosis. These four were chosen because they are relatively common among people already diagnosed with MS.

They used administrative and clinical databases in British Columbia, Canada, collecting data on a total of 7,829 people diagnosed with MS (patients) and 36,399 without MS (controls); most (over 70%) were female. The team examined the frequency of these symptoms during the five years prior to the first recorded demyelinating event (loss of myelin, a classic first MS symptom) or MS symptom onset/diagnosis. In other words, they examined the prodromal period.

Results showed that during these five years, all four symptoms were significantly more common in patients than in controls. Fatigue was 3.37 times more common, sleep disorders were 2.61 times more common, anemia was 1.53 times more common, and pain was 2.15 times more common among patients compared with the control group.

The association between anemia and MS was greater for men than women, and the link between pain and MS was stronger among older individuals. Patients were also more likely to visit a physician during the prodromal period than were controls.

Among a study population analyzed based on clinical data only (966 patients and 4,534 controls), sleep disorders and pain were significantly more prevalent over  the prodromal period among patients than controls — sleep disorders were 1.72 times more common, and pain was 1.53 times more common.

“Fatigue, sleep disorders, anaemia and pain were elevated before the recognition of MS,” the researchers concluded. “We also provide one of the first explorations of the effects of age and sex on the MS prodromal phenotype, finding a particularly elevated occurrence of anaemia among men who develop MS and a steady increase in pain during the MS prodrome with increasing age.”