Pain, Fatigue, Anxiety Common in First Year After CIS/MS Diagnosis

People newly diagnosed with clinically isolated syndrome (CIS) or multiple sclerosis (MS) frequently experience pain, fatigue, depression, and anxiety in the first year after diagnosis, a new study finds.

Fatigue was reported by almost two-thirds of new patients, and half experienced pain. Many individuals experienced multiple symptoms simultaneously, an analysis showed.

“The months following MS diagnosis are often a stressful period of uncertainty and change,” Thomas Valentine, PhD, the study’s lead author, said in a press release.

“Our findings highlight the importance of early and routine assessment of patients’ symptoms, so that those patients who might benefit from treatment can be identified and receive appropriate care,” Valentine said.

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The study, “Prevalence, co-occurrence, and trajectories of pain, fatigue, depression, and anxiety in the year following multiple sclerosis diagnosis,” was published in the Multiple Sclerosis Journal.

Like many diseases, MS affects individual patients differently. Some people experience relapses or periods in which one or more symptoms appear or worsen, followed by periods of partial or complete recovery. Others, conversely, have symptoms that progressively worsen with or without relapses.

Pain, fatigue, depression, and anxiety all are common symptoms in people with MS. However, the co-occurrence of these symptoms is unclear, as is how they evolve in the year following diagnosis.

To learn more, a team of researchers at Michigan Medicine – University of Michigan in the U.S. assessed questionnaires self-completed by 230 adults with CIS or MS. The questionnaires asked about disease symptoms one, two, three, six, and nine months after diagnosis, and at the one-year mark.

The results showed that 50.9% of respondents experienced pain, and 62.6% fatigue. Mental health symptoms were only slightly less common, with 47.4% reporting depression, and 38.7% experiencing anxiety.

Notably, many participants experienced multiple symptoms simultaneously — 21.3% experienced two symptoms, while 19.1% reported three, and 17.4% reported four symptoms.

“These results speak to the need for comprehensive screening,” said Valentine, an MS rehabilitation research fellow at Michigan Medicine. “One symptom can cause or aggravate other symptoms: fatigue, in particular, tends to cluster with pain, depression and anxiety.”

These findings should guide clinical visits and be used in determining patient care, Valentine said.

“If, for example, a patient reports significant fatigue, they should also be asked if they are experiencing pain and other symptoms,” he said. The researchers noted that “targeted symptom management is also key to improving quality of life.”

There is no cure for MS. Instead, its management relies on disease-modifying therapies that aim to prevent or reduce relapses.

However, personalized treatment approaches that consider individual symptoms may be more beneficial, the researchers said, based on this study’s findings.

“Clusters of symptoms as seen in many patients in the first year after MS diagnosis can seem challenging but may also present opportunity to identify treatments that address multiple symptoms at once,” said Anna Kratz, PhD, the study’s co-author and an associate professor of physical medicine and rehabilitation at Michigan Medicine.

“For instance, antidepressants can help with both mood and somatic symptoms. When clinicians see these clusters of symptoms, their minds should turn to the options that interdisciplinary rehabilitation care can offer to address multiple symptoms at once,” Kratz added.

Recent studies have found that special diets or multivitamins can help to ease symptoms, specifically those related to fatigue.

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After studying how the participants’ symptoms changed over the one-year period following diagnosis, the researchers found that although some patients with severe symptoms remained stable, symptom development and recovery rates varied between patients.

Some individuals who did not feel pain or fatigue in the first month after diagnosis reported it later on, while others who experienced depression or anxiety early did not report them later. These changes were very modest, suggesting that dramatic increases in symptoms are unlikely in the first year after diagnosis for those patients for whom MS presents a mild symptom burden.

Overall, the team concluded that “pain, fatigue, depression, and anxiety are prevalent in newly diagnosed MS,” and suggested that “prompt screening and evidence-based interventions are necessary if quality of life is to be optimized.”

The team noted that future studies should examine the links between progressive changes in symptom severity, disease activity, disability, and treatment as this could help optimize the determination of therapies and symptom prevention strategies for people with early MS.

“Finding the factors that predict symptom clustering, stability and change will help healthcare providers match prevention and treatment programs to patients,” Valentine said.

“We have many effective treatments, but more research is needed to optimize these tools for people with MS. This is particularly true for people early in diagnosis, which may prove to be an optimal time to initiate symptom prevention strategies,” Valentine concluded.