Studies Find MS Patients Need Early Help for Pain and Anxiety

Screening for depression also should happen quickly to maintain quality of life, two new studies of multiple sclerosis indicate.

Healthcare providers should offer multiple sclerosis (MS) patients help for pain, fatigue, depression or anxiety at the time of diagnosis rather than waiting, according to two new studies.

Clinically significant levels of pain, fatigue and depression, and anxiety were commonly seen in newly diagnosed patients, according to Kevin Alschuler, Ph.D., principal investigator and director of psychology service at the University of Washington Medicine’s Multiple Sclerosis Center, writing in Multiple Sclerosis Journal.

In their study, Alschuler and colleagues had newly diagnosed adults with MS/clinically isolated syndrome self-report measures of pain, fatigue, depression, and anxiety at one, two, three, six, nine, and 12 months after MS diagnosis. (Clinically isolated syndrome refers to the first episode of what may represent the onset of MS.)

They found that 60% of the patients experienced fatigue; 50% had pain, 47% went through depression, and 39% lived through anxiety within the first year of diagnosis.

“The take home was that we found these symptoms — pain, fatigue, depression and anxiety — quite prevalent” at the point of diagnosis, Alschuler said in a news release. “We want to address this immediately, rather than five or 10 years down the road,” he said.

A companion published in the Journal of Neurology followed the same cohort of 230 patients through the first year after their diagnosis.

Alschuler was also the lead author of this study. He and the research team examined the quality of life for patients immediately after, at two months, three months, six months, nine months and then one year after diagnosis.

They found that, on average, quality of life was high and stable.

“Patients who are newly diagnosed have to deal with the emotional impact of the diagnosis, as well as numerous tests and treatment decision-making,” Aschuler said. If the patients were “doing great” at diagnosis, they had a tendency to stay that way throughout the first year, Alschuler noted. “If they were struggling, they also tended to stay that way,” he added.

The stability in quality of life suggests that patients can be assessed early after diagnosis for key variables that are predictive of both current and future quality of life, the researchers noted.

Both Alschuler and Dawn Ehde, Ph.D., a clinical psychologist in the UW School of Medicine's Department of Rehabilitation Medicine and co-author of the Journal of Neurology study, are interested in early non-pharmaceutical interventions for common symptoms experienced by MS patients.

“Through symptom self-management, including cognitive behavioral therapy, we help patients become empowered with coping skills, especially in the areas of fatigue and pain,” Ehde said. “We teach them how to use strategies such as relaxation or mindfulness meditation techniques, as well as how to pace themselves to decrease fatigue and better manage stress.”

Patients who learn these skills often find that not only do their pain and fatigue lessen, they are able to do more of what is important to them despite their MS, Ehde said.

The next step for the research team is to explore options for early interventions to help newly diagnosed patients.