Effects of Multiple Sclerosis on Quality of Life

By Kara Nyberg, PhD
Reviewed By Claire S. Riley, MD, Assistant Professor of Neurology and Director, Columbia University Multiple Sclerosis Clinical Care and Research Center, New York, NY

Multiple sclerosis (MS) can be devastating to younger individuals given that it usually strikes during the peak productive ages of 20 to 50 years. When patients with MS are confronted with this potentially debilitating condition and the recognition that no cure for MS currently exists, their quality of life (QOL) can suffer.

Recent research indicates that patients with MS report QOL that falls more than 1 standard deviation below that of the general population (mean health state score 59.7 ± 22.4 for patients with MS versus 82.5 for the general population).¹ In this registry study of 4516 patients with MS, health-related QOL ranked poorly, particularly in men, older individuals, people with a long duration of MS, and those with a progressive form of the disease. Among the total cohort of MS patients, about 83% reported difficulties with usual activities, 76% indicated problems with pain or discomfort, 76% struggled with mobility, and 58% reported problems with anxiety or depression.

Although disease-modifying therapies hold promise for reducing MS symptoms, preventing relapse, and delaying disease progression, many of these agents produce little improvement in QOL.^2,3 This suggests that either better disease-modifying therapies or adjunctive treatments may be needed to improve specific MS symptoms in order to positively influence QOL.

Two comorbid conditions that are particularly relevant in individuals with MS and which are amenable to symptomatic treatment are pain and depression. “Researchers from our team and others in the field have consistently noted a strong association between depression and pain severity, but elements of the pain-depression relationship haven’t been fully researched, particularly in individuals with MS,” said Kevin Alschuler, PhD, acting assistant professor in the Department of Rehabilitation Medicine at the University of Washington School of Medicine in Seattle.

To better address this issue, Dr. Alschuler and colleagues surveyed 161 individuals with MS to evaluate the prevalence of pain and depression using a variety of methods for defining these conditions.⁴ The findings were striking: “As many as 1 in 5 patients with MS experience both pain and clinically significant depression, and 42% to 78% of patients with MS experience pain, depression, or both,” Dr. Alschuler noted.

The results not only reinforce the importance of considering both pain and depression in patients with MS, they also lend insight into the pattern of these comorbidities. For example, “When depression was present, pain was highly likely to also be present. Relatively few patients in our sample had depression without also having pain,” said Dr. Alschuler, who also found that patients with comorbid depression visited medical providers more frequently for pain relief and used a greater number of pain treatments than patients without comorbid depression.⁵

Recognizing that a large treatment gap in QOL exists for patients with MS is half the battle; the other half is taking proactive measures to address the situation. Dr. Alschuler believes that, in addition to managing symptoms and delaying disability progression, assessing and promoting patient QOL should be a primary goal of MS treatment.

“We’re very interested in having our research impact clinical practice and, in fact, believe that it has already helped us take our first steps in that direction,” said Dr. Alschuler, whose research team recently received grant funding for a study that seeks to improve the model of care for depression and pain in patients with MS.

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