Background & Aims

People with Multiple Sclerosis (MS) often report restrictions in social participation, which are associated with reduced health-related quality of life A limited understanding of how MS-related symptoms may impact social engagement in the daily lives of individuals with MS restricts rehabilitation efforts to maximize social participation in people with MS. Identifying symptoms that impact ability to participate in social roles and activities will allow for opportunities to intervene on modifiable factors to optimize social functioning. Fatigue is considered the most common and impactful symptom in MS; however, previous research indicates that pain may also play a role in ability to participate in social roles and activities. This study aimed to examine the association of fluctuations in pain with same-day associations in social participation in MS above and beyond the effects of same-day fluctuations in fatigue and average levels of symptoms (between-person level fatigue and pain).

Methods

This study involved a 14-day Ecological Momentary Assessment (EMA), utilizing a smartphone application to collect pain and fatigue intensity ratings (0-100 numerical rating scale) four times a day: upon waking up, at two quasi-random time points during the day, and at bedtime. Person-day-centered deviation scores for pain and fatigue were computed to indicate daily change in symptoms relative to each individual’s average pain/fatigue, enabling the examination of within- and between-person sources of variance. Daily social participation was assessed using the Neuro-QoL Ability to Participate in Social Roles & Activities 8-item Short Form, adapted for daily administration. Linear mixed-effects regression models were used to quantify the association between same-day symptoms and social participation.

Results

EMAs were completed by 227 individuals; out of a possible 56 EMA data points/person, 90.8% (11547/12712) were complete. The sample was predominantly female=79.0%, white=72.8%, with mean age=51.1±11.9, mean EMA pain rating=27.5±22.1, and mean EMA fatigue rating=38±17.35 Controlling for between-person levels of pain (?= -0.04; p=0.03) and fatigue (?= -0.16; p<0.001) and daily fluctuations of fatigue (?= -0.07; p<0.001), days of higher than usual pain were related to significantly lower same-day social participation (?= -0.03; p=0.004).

Conclusions

This study revealed that higher daily pain is associated with same-day lower social participation in people with MS; importantly, the effects of pain on participation were above and beyond the effects of fatigue, which is often a focus of clinical care in MS. While rehabilitation programs commonly prioritize addressing physical limitations and environmental obstacles to participation, this research emphasizes the significance of investigating and addressing “unseen” somatic symptoms that could impact social functioning in MS. Implementing a person-centered approach could assist individuals with mild symptom burdens in benefiting from personalized interventions aimed at mitigating the impact of daily symptom fluctuations on functional outcomes. For instance, developing strategies to manage pain flare-ups or fluctuations could enhance social participation within a given day.

References

1)Kratz, A. L., Murphy, S. L., & Braley, T. J. (2017). Pain, fatigue, and cognitive symptoms are temporally associated within but not across days in multiple sclerosis. Archives of physical medicine and rehabilitation, 98(11), 2151-2159
2)Kratz AL, Braley TJ, Foxen-Craft E, Scott E, Murphy 3rd JF, Murphy SL. How do pain, fatigue, depressive, and cognitive symptoms relate to well-being and social and physical functioning in the daily lives of individuals with multiple sclerosis? Arch Phys Med Rehabil 2017;98:2160–6.
3)Cella, D., Lai, J. S., Nowinski, C. J., Victorson, D., Peterman, A., Miller, D., . . . Moy, C. (2012). Neuro-QOL: brief measures of health-related quality of life for clinical research in neurology. Neurology, 78(23), 1860-1867. doi:10.1212/WNL.0b013e318258f744

Presenting Author

Duygu Kuzu

Poster Authors

Duygu Kuzu Basdogan

PhD

University of Michigan

Lead Author

E-mail

Sonia Sharma

University of Michigan

Lead Author

E-mail

Nora Fritz

PhD

Wayne State University

Lead Author

E-mail

Dawn Ehde

PhD

University of Washington

Lead Author

E-mail

Kevin Alschuler

PhD

University of Washington

Lead Author

E-mail

Tiffany Braley

MD

University of Michigan

Lead Author

E-mail

Susan Murphy

PhD

University of Michigan

Lead Author

E-mail

Daniel Whibley

MA

University of Michigan

Lead Author

E-mail

Anna Kratz

PhD

University of Michigan

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Pain in Chronic/Inflammatory Diseases