Background & Aims
Pain is one of the most common symptoms of multiple sclerosis (MS). With more than 50% of individuals with MS reporting chronic pain, it has been associated with poor physical functioning and quality of life in this population. Falls are also a common concern among individuals with MS and can lead to serious consequences including physical injuries, fear of falling, decreased confidence in performing activities of daily living, and reduced social participation. Several risk factors associated with falls have been identified; however, the association between pain and falls remains unknown. Understanding the contribution of pain on falls may be helpful to improve falls prevention approaches in MS. The purpose of this study was to examine the association between daily within-person variation of pain and same-day falls among individuals with MS.
Methods
Participants completed a protocol of 14 days of ambulatory assessment, with data collected via a smartphone app 4X/day at wake up, two quasi-random time points during the day, and at bedtime. Ecological momentary assessment (EMA) of self-reported pain intensity was rated on a 0-100 numerical rating scale. Person-centered deviation scores for pain were created to reflect daily change in pain levels relative to each person’s average pain. Falls data were collected 2x/day at wake up (overnight falls) and at bedtime (falls during the day) and were combined into presence or absence of falls per day. Falls were defined as a slip or trip where participants lost balance and landed on the floor, ground or lower level. Multilevel binary logistic regression was used to examine the daily association between pain (continuous) and falls (Yes/No).
Results
A total of 227 participants completed the assessments. Out of a total 30 EMA data points/person, 94.9% (3539/3728) were complete. Consistent with the literature about demographics in MS, most participants were female (79.0%), white (73.1%), with mean age=51.14 ± 11.92 years, and mean EMA pain rating=27.5 ± 22.1. The proportion of Patient Determined Disease Steps ranged from 28.2% for normal to 5.73% for bilateral support and all MS subtypes were included. A total of 67 falls were recorded. Individuals with higher average pain over the 14 days were found to be at higher risk of experiencing falls (OR = 1.02; 95% CI, 1.00 to 1.03; p = 0.02). Moments of higher-than average pain were not associated with falls (OR = 1.00; 95% CI, 0.98 to 1.03; p = 0.79).
Conclusions
Pain intensity is associated with falls among individuals with MS. Specifically, individuals with higher average daily pain intensity are more likely to fall. Incorporating pain as a risk factor for falls maybe useful to provide a more comprehensive assessment of risk factors for falls in MS. Future studies should examine whether pain phenotype (e.g., predominance of nociceptive, neuropathic or nociplastic pain) influences the likelihood of falling. Future studies should also examine effects of pain on falls within the context of disability levels and co-occurring MS symptoms including fatigue, cognitive dysfunction, depression, and sleep disturbances.
References
1.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.
2.Abou L, McCloskey C, Wernimont C, Fritz NE, Kratz AL. Examination of Risk Factors Associated With Falls and Injurious Falls in People With Multiple Sclerosis: An Updated Nationwide Study. Arch Phys Med Rehabil. 2023 Dec 1:S0003-9993(23)00665-2
3.Lamb SE, Jørstad-Stein EC, Hauer K, Becker C. Prevention of Falls Network Europe and Outcomes Consensus Group. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc 2005;53:1618–22
4.Carling A, Forsberg A, Nilsagard Y. Falls in people with multiple sclerosis: experiences of 115 fall situations. Clin Rehabil 2018;32: 526–35.
5.Sliwinski, M. J., Mogle, J. A., Hyun, J., Munoz, E., Smyth, J. M., & Lipton, R. B. (2018). Reliability and validity of ambulatory cognitive assessments. Assessment, 25(1), 14-30.
Presenting Author
Libak Abou
Poster Authors
Libak Abou
PhD, MPT, PT
University of Michigan
Lead Author
Sonia Sharma
University of Michigan
Lead Author
Nora Fritz
PhD
Wayne State University
Lead Author
Dawn Ehde
PhD
University of Washington
Lead Author
Kevin Alschuler
PhD
University of Washington
Lead Author
Tiffany Braley
MD
University of Michigan
Lead Author
Daniel Whibley
MA
University of Michigan
Lead Author
Anna Kratz
PhD
University of Michigan
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Pain in Chronic/Inflammatory Diseases