Pain linked to perceived cognitive difficulties in MS study
Perception does not predict performance on objective cognition tests
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In people with multiple sclerosis, pain is associated with more reported difficulties with thinking and memory, but does not predict how patients perform on objective cognition tests, a study reports.
- Patients with MS often experience pain, which is linked to perceived difficulties with thinking and memory.
- Pain and fatigue do not reliably predict actual performance on objective cognitive tests in these patients.
- Evaluating cognitive concerns requires considering broader symptom burdens, including pain and fatigue.
In people with multiple sclerosis (MS), pain is associated with more reported difficulties with thinking and memory, but does not predict how patients perform in objective cognition tests, according to a recent study.
Mental health issues, along with pain and fatigue, were associated with greater perceived cognitive problems.
“Given that subjective cognitive difficulties are associated with clinically relevant outcomes, including reduced occupational functioning and quality of life, the observed relationship between pain and perceived cognition may have clinical relevance,” researchers wrote.
The study, “Pain and cognition in multiple sclerosis: distinct associations with objective and perceived impairment,” was published in Multiple Sclerosis and Related Disorders.
Most patients met criteria for cognitive impairment
People with MS can experience a wide range of symptoms that may affect attention, memory, how quickly people process information (processing speed), and their ability to plan or solve problems.
Although some studies suggest that people living with MS who experience pain may have poor cognitive abilities, it remains unclear how closely these symptoms are related.
To learn more, researchers in Canada analyzed data from 396 adults with MS who had been referred to an MS neuropsychiatry clinic between April 2025 and April 2026. Participants had a mean age of 43.8 years, and most were women (71.5%) and had relapsing–remitting MS (86.6%).
The researchers assessed cognitive abilities using the Minimal Assessment of Cognitive Function in MS battery, a series of tests covering aspects such as memory, processing speed, visuospatial functioning (skills needed to navigate the environment and recognize objects), problem-solving, and finding words from memory (verbal fluency). Overall, 64.9% of participants met the study’s criteria for cognitive impairment, which required failing at least two tests.
People with more severe pain tended to report more cognitive problems
Participants described their pain using the Short-Form McGill Pain Questionnaire. People reporting more pain tended to perform slightly worse on some cognitive tests, particularly those measuring verbal memory, spatial awareness, and problem-solving.
The emotional distress associated with pain was linked to difficulties across a broader range of cognitive domains, which also included difficulties with learning and memory, processing speed, visuospatial functioning, and finding words. People reporting greater emotional distress were also more likely to meet the study’s criteria for cognitive impairment. However, these associations were modest.
Better intellectual ability before the onset of MS was consistently associated with better test performance, while greater neurological disability was linked to poorer results. Older age was also associated with lower scores in some cognitive domains, including processing speed, visual memory, and problem-solving.
The results were different when participants’ self-reported cognitive difficulties were considered. People experiencing more severe pain tended to report more cognitive problems, even after accounting for mood, fatigue, and objective cognitive performance. Anxiety, depression, and fatigue were also associated with greater perceived cognitive difficulties.
These findings highlight a dissociation between objective and subjective cognition in MS and underscore the importance of considering symptom burden when evaluating cognitive concerns.
Importantly, participants’ self-reported cognitive problems did not correspond directly to their performance on cognitive tests. In other words, people who felt they were experiencing difficulties with their cognitive abilities did not necessarily perform worse on the tests.
“These findings highlight differing relationships between pain and objective versus perceived cognition in MS and underscore the importance of considering pain alongside mood, fatigue, and other symptom-related factors when evaluating cognitive concerns in [people with MS],” the researchers wrote.
The team noted that the study cannot establish whether pain causes cognitive difficulties because the analysis examined participants at a single point in time. In addition, “participants were drawn from a specialized MS neuropsychiatry service and all had cognitive concerns, introducing the potential for referral bias and limiting generalizability to the broader MS population,” they added.
Overall, “these findings highlight a dissociation between objective and subjective cognition in MS and underscore the importance of considering symptom burden when evaluating cognitive concerns,” the investigators concluded.
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