Symptom Co-occurrences Associated with Smoking Among Individuals with Relapsing-Remitting Multiple Sclerosis

Pamela Newland, RN, PhD, CMSRN; Louise Flick, DrPH, MSN, MPE; Hong Xian, PhD;Florian P. Thomas, MD, MA, PhD

Correspondence: Pamela Newland, RN, PhD, CMSRN, Goldfarb School of Nursing at Barnes Jewish College, 4483 Duncan Ave., St Louis, MO 63110; e-mail: Pamela.Newland@bjc.org.

Background: The impact of tobacco on multiple sclerosis (MS) disease process and symptoms is complex and not clearly understood. Tobacco may be used to self-treat symptoms but also appears to intensify others. Studies to date have not characterized co-occurring symptoms (symptom patterns) and their association with tobacco use.

Methods: This study describes tobacco use among patients with relapsing-remitting MS (RRMS) and associated symptoms and symptom co-occurrences. In this cross-sectional study, 101 participants with an average age of 43 years completed a survey adapted from the Behavioral Risk Factor Surveillance System and the revised MS Related Symptom Scale (R-MS-RS). Data reduction was performed using factor analysis on the 43 items of the R-MS-RS, and linear regression was used to detect association between symptom clusters (factors) and smoking.

Results: Using the factor analysis result, the linear regression analysis found that tobacco use is positively associated with co-occurring symptoms and symptoms of Factor 1: Mental/Emotional (anxiety, loneliness, depression, and difficulty sleeping) and Factor 4: Neuro/Autonomic (urinary).

Conclusions: Smoking is associated with patterns of symptoms. Study of MS and tobacco use over time will allow determination of the temporal pattern of tobacco use and MS symptoms.