Disease-modifying therapies don’t affect pain for most MS patients
Survey-based study: As few as one-third of participants reported change in pain
- Most people with multiple sclerosis find disease-modifying therapies do not affect their pain.
- A minority reported pain changes; some DMTs decreased pain, while others increased it.
- The decision to use DMTs for multiple sclerosis should not be based on potential pain effects, researchers say.
For most people with multiple sclerosis (MS), the use of disease-modifying therapies, or DMTs, does not affect their perceived pain, according to a survey-based study in Australia.
As few as one-third of MS patients who had ever used DMTs reported a change in pain, while one-eighth of those currently using DMTs reported such a change, the survey showed.
“With a significant majority of participants not experiencing a change in their pain due to DMT use, the choice of DMT should not be influenced by a possible effect on pain,” the researchers wrote.
The study, “Perceived impact of disease modifying therapies on pain in people with multiple sclerosis: A mixed methods study,” was published in Multiple Sclerosis and Related Disorders by a team of researchers in Australia.
Disease-modifying therapies modulate immune activity to reduce MS relapses
In MS, abnormal immune responses damage the protective covering of nerve fibers, ultimately resulting in nerve cell loss in the brain and spinal cord. Up to three-quarters of people with MS are reported to experience significant pain, which can range from deep, aching pain to persistent burning or stabbing sensations.
DMTs modulate or suppress immune activity to reduce MS relapses, limit new lesion formation, and slow disability progression. By influencing immune-driven inflammation, they may also help ease MS-related pain. However, current evidence supporting their effect on pain remains limited.
“Understanding the impact that DMTs have on pain may affect shared decision making, as well as pain management decision recommendations,” the researchers wrote.
With this in mind, the team asked people with MS participating in the Australian MS Longitudinal Study about their experiences with DMTs and pain. The study included 764 participants (83.1% women) who reported regular pain and had ever used or were currently using DMTs. Most (88.1%) were using pain medications.
Among MS patients who had ever used a DMT in their lifetime, 30% said that one or more of the DMTs had reduced or increased pain severity or frequency. One-third (33%) believed DMTs had no effect, and the remaining 37% said they didn’t know.
Of the patients who reported that DMTs affected their pain, 99% provided data on the severity or frequency of pain associated with one or more DMTs. More than one-fourth (29%) reported a reduction in pain severity, while nearly one-fourth (23%) reported pain worsening. Similar results were seen for pain frequency.
Injectable DMTs more likely to be reported to increase pain severity
Injectable DMTs, including Copaxone (glatiramer acetate), interferon beta-1a (Avonex, Plegridy, or Rebif), and Betaseron (interferon beta-1b), were more likely to be reported to increase pain severity and frequency.
In contrast, infusion DMTs — specifically Tysabri (natalizumab) — and certain other DMTs, including Aubagio (teriflunomide), were more likely to be reported to decrease pain severity and frequency.
“The numbers of other DMTs were insufficient to draw conclusions,” the team wrote.
Pain severity-related responses were found to vary significantly by overall pain severity, disability level, and age, but not depression status. Pain frequency differences were linked to age and disability level.
Among MS patients currently using DMTs, 87.2% reported that their current DMT had no impact on pain or that they were unsure of the impact. Only 10% reported a reduction in pain severity, while 2.8% reported pain worsening. Similar results were observed for pain frequency.
A decrease in pain severity and frequency was more likely to be reported for MS patients using Tysabri, teriflunomide, or Mavenclad (cladribine). The number of individuals currently using other DMTs was too low to draw conclusions on individual therapies.
As most DMTs affect the immune component of MS, it is unlikely that pain in [people with MS] is directly modulated by immune or inflammatory processes.
No significant differences were found in pain severity- or pain frequency-related responses across pain severity, disability level, depression status, or age group.
Researchers also conducted focus group meetings with 26 participants, mostly older and middle-aged women, to gain insight into their lived experiences with DMTs and pain. Individuals in younger age groups did not want to be involved.
Overall, results from the focus groups provided little evidence that DMT usage was associated with the lived experience of pain.
“… I am still on an injectable disease-modifying therapy … But I don’t think it’s helping any way, shape, or form with pain,” said a woman in the middle-aged group.
Most participants did not experience a change in pain due to DMT use, the researchers wrote.
“As most DMTs affect the immune component of MS, it is unlikely that pain in [people with MS] is directly modulated by immune or inflammatory processes,” they added. “Therefore, the choice of DMT does not need to be influenced by considerations about whether DMTs will impact pain in [people with MS].”
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