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An Empirical Investigation of a Biopsychosocial Model of Pain in Multiple Sclerosis

Day, Melissa A. PhD*; Ehde, Dawn M. PhD; Ward, L. Charles PhD; Hartoonian, Narineh PhD†,§,∥; Alschuler, Kevin N. PhD; Turner, Aaron P. PhD†,§,∥; Kraft, George H. MD; Jensen, Mark P. PhD

doi: 10.1097/AJP.0000000000000240
Original Articles

Objectives: Pain is a significant problem for many individuals with multiple sclerosis (MS). Pain is often associated with other MS symptoms (eg, physical, sensorimotor, cognitive declines), and both pain and MS symptoms are hypothesized to contribute to psychosocial problems (eg, depression), other symptoms (eg, fatigue, sleep disturbance), and functional impairments (eg, pain interference). On the basis of a biopsychosocial model, we sought to: (1) examine the associations between pain, MS symptoms, depression, psychosocial, and functional variables and (2) identify possible risk and protective factors associated with pain in MS.

Materials and Methods: A cross-sectional survey was completed by 424 individuals with MS. Pain, MS symptoms, demographics, MS diagnostic factors, and psychosocial and functional variables were assessed. Data were analyzed by structural equation models.

Results: Participants were predominantly white (92%), middle-aged (mean=50.7 y), and female (80%). Results indicated that pain severity and depression accounted for >50% of the variance in pain interference. Although pain contributed minimally to fatigue and sleep quality, depression and MS symptoms predicted 49% of the variance in fatigue, and depression was largely responsible for the 40% of predicted variance in sleep quality. Identified risk factors for pain were low educational attainment and lack of a committed/marital relationship, even while controlling for diagnostic and other key demographic variables.

Discussion: Results highlight the importance of targeting interventions toward improving coping skills and social support within the context of pain and MS. Research is needed to determine whether effectively targeting depression in MS results in improvements of other critical psychosocial and physical functioning domains.

*School of Psychology, The University of Queensland, Brisbane, Qld, Australia

Department of Rehabilitation Medicine, University of Washington

§VA Puget Sound Health Care System, Seattle, WA

Psychology Service, VA Medical Center, Tuscaloosa, AL

VA MS Center of Excellence, West, Seattle

Supported by grants from the Department of Education, NIDRR grant number H133B080025, Washington, DC; National Institutes of Health, Grant 5U01AR052171-03, Bethesda, Maryland; and the National Multiple Sclerosis Society, Grants MB 0026 and MB 0008, New York City, NY. The authors declare no conflict of interest.

Reprints: Melissa A. Day, PhD, School of Psychology, The University of Queensland, 1100 Nudgee Rd, Brisbane, Qld 4014, Australia (e-mail:

Received July 16, 2014

Received in revised form April 2, 2015

Accepted April 1, 2015

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