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Solsona EM, Tektonidis T, Reece JC, Simpson-Yap S, Black LJ, Rad EY, Coe S. Associations between diet and disease progression and symptomatology in multiple sclerosis: A systematic review of observational studies. Mult Scler Relat Disord 2024; 87:105636. [PMID: 38678968 DOI: 10.1016/j.msard.2024.105636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Although many people with MS (pwMS) modify their diet after diagnosis, there is still no consensus on dietary recommendations for pwMS. A number of observational studies have explored associations of diet and MS progression, but no studies have systematically reviewed the evidence. This systematic review aimed to provide an objective synthesis of the evidence for associations between diet and MS progression, including symptoms and clinical outcomes from observational studies. METHODS We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic database searches were performed for studies completed up to 26 July 2023 using PubMed (Medline), Web of Science, CINAHL, Embase (Ovid), and Scopus, followed by citation and reference list checking. We included studies using diet quality scores or dietary indices. Studies assessing individual foods, nutrients, or dietary supplements were excluded. We used the Newcastle-Ottawa Scale to assess the risk of bias of included studies. RESULTS Thirty-two studies met the inclusion criteria. Of these, 20 were cross-sectional and 12 prospective. The most frequent outcomes assessed were disability (n = 19), quality of life (n = 12), fatigue (n = 12), depression (n = 9), relapse (n = 8), anxiety (n = 3), and magnetic resonance imaging (MRI) outcomes (n = 4). Based on prospective studies, this review suggests that diet might be associated with quality of life and disability. There were also potential effects of higher diet quality scores on improved fatigue, disability, depression, anxiety, and MRI outcomes but more evidence is needed from prospective studies. CONCLUSIONS Observational studies show some evidence for an association between diet and MS symptoms, particularly quality of life and disability. However, the impact of diet on other MS outcomes remains inconclusive. Ultimately, our findings suggest more evidence is needed from prospective studies and well-designed tailored intervention studies to confirm associations.
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Affiliation(s)
| | | | - Jeanette C Reece
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Lucinda J Black
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | | | - Shelly Coe
- Oxford Brookes Centre for Nutrition and Health, Oxford, United Kingdom.
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Hrušková N, Berchová Bímová K, Davies Smith A, Škodová T, Bičíková M, Kolátorová L, Štětkářová I, Brožek Ľ, Javůrková A, Angelová G, Řasová K. People with newly diagnosed multiple sclerosis benefit from a complex preventative intervention-a single group prospective study with follow up. Front Neurol 2024; 15:1373401. [PMID: 38660088 PMCID: PMC11039797 DOI: 10.3389/fneur.2024.1373401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Background Newly diagnosed people with multiple sclerosis frequently report fatigue, pain, depression and anxiety. Preventative programmes may be beneficial, but there is limited evidence of their effectiveness, especially long-term follow-up. Methods The programme consisted of 6-month face to face intervention (an introductory workshop, psychology-led group sessions and individual physical therapy) followed by 6-month self-guided therapy. Outcome measures were taken at baseline, 6 and 12 months. Primary outcomes measures were self-report questionnaires for fatigue, satisfaction with life and disease acceptance. Secondary outcomes were spirometry, spiroergometric parameters and neuroactive steroid levels. Results From 22 participants enrolled, 17 completed the first 6 months and 13 the follow-up. Fatigue measured on the Fatigue scale for motor and cognitive functions decreased significantly at 6 months (p = 0.035) and at follow-up (p = 0.007). The Modified Fatigue Impact Scale (p = 0.035) and Satisfaction With Life Scale (p = 0.007) significantly increased at follow-up. Spirometry, spiroergometric parameters, steroid hormones and neuroactive steroids levels did not change significantly. Conclusion This programme reduces fatigue and improves satisfaction with life in this patient group with improvements sustained at 12 months. People who participated more frequently showed greater benefit. Clinical rehabilitation impact The paper describes the effects of a complex preventative intervention for people with newly diagnosed Multiple Sclerosis. The study found that this programme reduces fatigue and improves satisfaction with life with long-term benefit (at 12-month follow up). The individuals who participated less frequently experienced fewer benefits.
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Affiliation(s)
- Natália Hrušková
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Kateřina Berchová Bímová
- Department of Applied Ecology, Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czechia
| | - Angela Davies Smith
- MS Research, Treatment and Education, The Vassall Centre, Bristol, United Kingdom
| | - Tereza Škodová
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czechia
| | - Marie Bičíková
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czechia
| | - Lucie Kolátorová
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czechia
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Ľuba Brožek
- Mediterra s.r.o., Malvazinky Rehabilitation Clinic, Prague, Czechia
| | - Alena Javůrková
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Gabriela Angelová
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Kamila Řasová
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czechia
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Cano-Sánchez J, Aibar-Almazán A, Hita-Contreras F, Afanador-Restrepo DF, Martínez-Amat A, Achalandabaso-Ochoa A, Carcelén-Fraile MDC. Is Resistance Training an Option to Improve Functionality and Muscle Strength in Middle-Aged People with Multiple Sclerosis? A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1378. [PMID: 38592200 PMCID: PMC10932173 DOI: 10.3390/jcm13051378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Currently, it is essential to adopt physical therapy strategies, such as resistance training, to enhance muscle strength and gait in middle-aged individuals (ages 45-65) suffering from Multiple Sclerosis. This is crucial in combating the typical symptoms of neurodegenerative diseases associated with functional loss. The objective of this study is to determine the effects of resistance training interventions on walking and muscle strength in middle-aged people with Multiple Sclerosis. Methods: A systematic review with meta-analysis was conducted by searching specific keywords in the PubMed, Scopus, Cochrane, and Web of Science databases. For inclusion, studies had to incorporate resistance training as a primary or significant component of the overall intervention for middle-aged patients with MS. Out of the 3675 articles identified, 12 randomized clinical trials met the criteria for inclusion in the review, with resistance training being a consistent feature in all of them. Results: Muscle strength and gait were evaluated as the main variables, with fatigue and the quality of life as secondary variables. This review reveals that resistance training significantly improves muscle strength. Resistance training achieves modest and non-significant improvements in gait. Notably, studies combining resistance training with motor control exercises achieve results of greater clinical significance in terms of gait. However, resistance training yields variable positive effects on perceived fatigue and the quality of life. Conclusion: Resistance training is useful for improving muscle strength; however, walking needs to be combined with motor control training.
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Affiliation(s)
- Javier Cano-Sánchez
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain (A.A.-O.)
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain (A.A.-O.)
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain (A.A.-O.)
| | | | - Antonio Martínez-Amat
- Faculty of Health Sciences and Sport, University Foundation of the Área Andina-Pereira, Pereira 660004, Colombia
| | | | - María del Carmen Carcelén-Fraile
- Department of Education and Psychology, Faculty of Social Sciences, University of Atlántico Medio, 35017 Las Palmas de Gran Canaria, Spain
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Rivel M, Achiron A, Stern Y, Zeilig G, Defrin R. Emotional burden among MS patients: associations between specific chronic pain diagnoses and psychological features. J Neurol 2024; 271:688-698. [PMID: 37875677 DOI: 10.1007/s00415-023-12048-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
Central neuropathic pain (CNP) and musculoskeletal pain (MSP) are often comorbid with multiple sclerosis (MS), yet data on the emotional burden entailed by this comorbidity are very limited. We studied whether MS patients with CNP exhibited greater emotional burden and pain severity than those with MSP and whether this emotional burden was attributed to the MS, the chronic pain, or both. Participants were 125 MS patients (55 with CNP; 30 with MSP; 40 MS pain-free) and 30 healthy controls (HCs). Participants completed questionnaires assessing pain interference, pain catastrophizing, depression, anxiety, stress, hypervigilance, and chronic pain. Group comparisons and a two-step cluster analysis were performed, and the association between cluster membership and clinical group membership was evaluated. Chronic pain was stronger and more widespread in the CNP group than in the MSP group. Both pain groups had higher pain interference, pain catastrophizing, and stress compared to MS pain-free and HC groups. All MS groups had greater depression levels compared to HCs, and the CNP group had the highest anxiety level. The "high psychological distress" cluster comprised mainly participants with CNP (57%), and the "minimal psychological distress" cluster comprised mainly the MS pain-free and HC groups. In conclusion, CNP seems to induce greater emotional burden and pain severity than does MSP. Whereas depression may be attributed to MS, and anxiety to CNP, enhanced pain interference, catastrophizing, and stress may be attributed to the comorbidity of MS and chronic pain. Identifying these traits among MS patients and targeting them in management programs may contribute to more effective, individually based care.
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Affiliation(s)
- Michal Rivel
- Department of Physical Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anat Achiron
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Stern
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Gabi Zeilig
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurological Rehabilitation, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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Abou L, Whibley D, Clauw DJ, Kratz AL. Widespread Pain With Nociplastic Features is an Independent Predictor of Low Physical Activity in People with Multiple Sclerosis. THE JOURNAL OF PAIN 2024; 25:418-427. [PMID: 37741524 DOI: 10.1016/j.jpain.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/17/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
Exploring the relationship between underlying pain mechanisms and physical activity could inform interventions to optimize physical activity in persons with multiple sclerosis (PwMS). This cross-sectional nationwide survey examined whether pain phenotype is a significant predictor of self-reported physical activity in PwMS. The study included 938 persons with a self-reported diagnosis of MS (93% reported neurologist-diagnosed MS) who completed surveys of demographic, clinical information, pain intensity, indicators of underlying pain mechanisms (Fibromyalgia Survey Criteria and painDETECT), and physical activity (Godin Leisure-Time Exercise Questionnaire). Responses were used to categorize pain phenotypes as widespread pain with nociplastic features (WPNF), neuropathic, nociceptive, or mixed (neuropathic/WPNF). Following current physical activity guidelines, self-reported physical activity was categorized as active or insufficiently active/sedentary. Applying multivariable logistic regression, participants with no chronic pain had 2.30 higher odds of being physically active when compared to participants with chronic mixed pain. Similarly, participants with neuropathic and nociceptive pain had, respectively, 1.90 and 1.66 higher odds of being physically active compared to individuals with mixed pain. Higher scores on the fibromyalgia survey criteria (operationalized in this study as an indicator of WPNF) were a significant independent predictor of insufficient physical activity (OR = .93, P < .01). Findings indicate that experience and phenotype of chronic pain, in particular WPNF, are associated with physical inactivity in PwMS. This suggests that assessing pain phenotype may be important to identify individuals at risk of inadequate physical activity and may guide the tailoring of behavioral therapeutic approaches to help PwMS achieve the recommended level of physical activity. PERSPECTIVE: This study examines the association between pain mechanism and physical activity in multiple sclerosis. These findings highlight the possibility that a basic screening for pain mechanism could offer clinically useful information without requiring extensive neurobiological phenotyping and may inform the development of behavioral interventions to enhance physical activity in multiple sclerosis.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Daniel Whibley
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Clauw
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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Moscato S, Orlandi S, Di Gregorio F, Lullini G, Pozzi S, Sabattini L, Chiari L, La Porta F. Feasibility interventional study investigating PAIN in neurorehabilitation through wearabLE SensorS (PAINLESS): a study protocol. BMJ Open 2023; 13:e073534. [PMID: 37993169 PMCID: PMC10668325 DOI: 10.1136/bmjopen-2023-073534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/28/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Millions of people survive injuries to the central or peripheral nervous system for which neurorehabilitation is required. In addition to the physical and cognitive impairments, many neurorehabilitation patients experience pain, often not widely recognised and inadequately treated. This is particularly true for multiple sclerosis (MS) patients, for whom pain is one of the most common symptoms. In clinical practice, pain assessment is usually conducted based on a subjective estimate. This approach can lead to inaccurate evaluations due to the influence of numerous factors, including emotional or cognitive aspects. To date, no objective and simple to use clinical methods allow objective quantification of pain and the diagnostic differentiation between the two main types of pain (nociceptive vs neuropathic). Wearable technologies and artificial intelligence (AI) have the potential to bridge this gap by continuously monitoring patients' health parameters and extracting meaningful information from them. Therefore, we propose to develop a new automatic AI-powered tool to assess pain and its characteristics during neurorehabilitation treatments using physiological signals collected by wearable sensors. METHODS AND ANALYSIS We aim to recruit 15 participants suffering from MS undergoing physiotherapy treatment. During the study, participants will wear a wristband for three consecutive days and be monitored before and after their physiotherapy sessions. Measurement of traditionally used pain assessment questionnaires and scales (ie, painDETECT, Doleur Neuropathique 4 Questions, EuroQoL-5-dimension-3-level) and physiological signals (photoplethysmography, electrodermal activity, skin temperature, accelerometer data) will be collected. Relevant parameters from physiological signals will be identified, and AI algorithms will be used to develop automatic classification methods. ETHICS AND DISSEMINATION The study has been approved by the local Ethical Committee (285-2022-SPER-AUSLBO). Participants are required to provide written informed consent. The results will be disseminated through contributions to international conferences and scientific journals, and they will also be included in a doctoral dissertation. TRIAL REGISTRATION NUMBER NCT05747040.
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Affiliation(s)
- Serena Moscato
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Silvia Orlandi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Health Science and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Di Gregorio
- UOC Medicina Riabilitativa e Neuroriabilitazione, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy
- Centro studi e ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum - Università di Bologna, Cesena, Italy
| | - Giada Lullini
- IRCCS Istituto delle Scienze Neurologuche di Bologna, Bologna, Italy
| | - Stefania Pozzi
- DATER Riabilitazione Ospedaliera, UA Riabilitazione, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy
| | | | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Health Science and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Fabio La Porta
- IRCCS Istituto delle Scienze Neurologuche di Bologna, Bologna, Italy
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7
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Gaballah S, El-Deen DS, Hebeshy MI. Effect of effleurage massage therapy on sleep disturbance, fatigue, pain, and anxiety in patients with multiple sclerosis: A quasi-experimental study. Appl Nurs Res 2023; 73:151719. [PMID: 37722787 DOI: 10.1016/j.apnr.2023.151719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/26/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Fatigue, pain, sleep disturbance, and anxiety are prevalent symptoms of multiple sclerosis (MS) and frequent complaints in MS patients, which reduce their quality of life. Many studies have shown that massage therapy improves MS patients' symptoms. However, the effect of effleurage massage on sleep disturbance, fatigue, pain, and anxiety in patients with MS is not studied in Egypt. AIM To examine the effect of Effleurage massage therapy on sleep disturbance, fatigue, pain, and anxiety in patients with multiple sclerosis (MS). METHODS This research study has a quasi-experimental design, with control and intervention groups, and pre and post-tests conducted at the multiple sclerosis in-patient clinic at one Egyptian hospital between May 2019 and January 2020. Sixty adult female patients with MS were recruited, with 30 patients in the control group and 30 in the intervention group. The intervention group received Effleurage massage therapy intervention three times a week for two weeks, and each session lasted about 20 min. Patients in the control group received routine hospital care. Data were collected using the patient's demographic and medical data sheet, Insomnia Severity Index, Modified Fatigue Impact Scale, Numeric Pain Rating Scale, and Beck Anxiety Inventory before and after the intervention. RESULTS Significant improvement was observed in pain, sleep, fatigue, and anxiety in the massage group (P < 0.001). CONCLUSION Based on the current study, Effleurage massage intervention for MS patients could have possible clinical value for improving sleep disturbance, palliating pain, fatigue, and reducing anxiety. Egyptian nurses can integrate massage therapy into the routine nursing care of patients with MS. Effleurage massage could be an adjunct treatment modality for MS patients; however, more significant studies are needed.
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Affiliation(s)
- Samia Gaballah
- Medical-Surgical Nursing, Faculty of Nursing, Suez Canal University, Egypt.
| | - Dalia Salah El-Deen
- Medical-Surgical Nursing, Faculty of Nursing, Cairo University, Kasr EL ainy, Cairo, Egypt.
| | - Mona Ibrahim Hebeshy
- Medical-Surgical Nursing, Faculty of Nursing, Suez Canal University, Egypt; School of Nursing, University of Northern Colorado, Greeley, USA.
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Stratton C, Vassilopoulos A, Brenton JN, Potter K, Vargas W, Rumm H, Bartels A, Bailey M, Odonkor C, Stoll S, Zempsky EWT, Yeh EA, Makhani N. Interim guidelines for the assessment and treatment of pain in children with multiple sclerosis. Front Neurosci 2023; 17:1235945. [PMID: 37781253 PMCID: PMC10536169 DOI: 10.3389/fnins.2023.1235945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Pain in multiple sclerosis (MS) is common, but literature on pain in children with MS remains scarce. Pain has physical, psychological, and social implications in MS, and both comprehensive assessment and interdisciplinary management approaches are needed. We sought to develop an interdisciplinary interim guideline for the assessment and management of pain in children with MS. Methods and materials We convened a modified Delphi panel composed of 13 experts in pediatric and adult MS neurology, physiotherapy, pain, patient lived-experience, advanced practice nursing, psychology, physiatry, and MS research. A survey was sent to panelists for anonymous completion. The panel discussed survey themes extracted by the panel chair. The process was repeated twice. Results Thirteen assessment and treatment recommendations were produced regarding pain in children with MS. Discussion Future studies will assess implementation of these pain assessment and treatment guidelines in the clinical setting.
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Affiliation(s)
- Catherine Stratton
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Areti Vassilopoulos
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - J. Nicholas Brenton
- Division of Pediatric Neurology, Department of Neurology, University of Virginia Medical Center, Charlottesville, VA, United States
| | - Kirsten Potter
- Department of Physical Therapy, Tufts University, Medford, MA, United States
| | - Wendy Vargas
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Department of Neurology, New York-Presbyterian NYP/Columbia University Irving Medical Center, New York, NY, United States
| | - Heather Rumm
- Connecticut Chapter, National Multiple Sclerosis Society, Hartford, CT, United States
| | - Andrea Bartels
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Mary Bailey
- Trinity Health of New England, Hartford, CT, United States
| | - Charles Odonkor
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
- Yale New Haven Health Old Saybrook Medical Center, Old Saybrook Medical Center, New Haven, CT, United States
| | - Sharon Stoll
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
- Yale MS Center, North Haven, CT, United States
| | - E. William T. Zempsky
- Division of Pain & Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT, United States
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, United States
| | - E. Ann Yeh
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Neuroscience and Mental Health, Department of Paediatrics (Neurology), Hospital for Sick Children, SickKids Research Institute, Toronto, ON, Canada
| | - Naila Makhani
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
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9
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Chand RR, Blyth FM, Khalatbari-Soltani S. Healthy dietary indices and noncancer pain: a systematic review of cross-sectional and longitudinal studies. Pain 2023; 164:e177-e189. [PMID: 36083185 DOI: 10.1097/j.pain.0000000000002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Pain is a global public health problem given its high prevalence and incidence, long duration, and social and economic impact. There is growing interest in nutrition as potential modifiable risk factor related to pain; however, the associations between healthy dietary patterns and pain have not yet been well established. Thus, we aimed to systematically review and synthesise current cross-sectional and longitudinal evidence on the relationship between a priori healthy dietary patterns and noncancer pain among adults aged ≥18 years. We identified relevant published cross-sectional and longitudinal studies by systematically searching several electronic databases from inception to September 2021. Risk of bias was assessed using the modified Newcastle-Ottawa scale for cohort studies. A total of 14 cross-sectional and 6 longitudinal studies were included in the review. These studies measured different dietary scores/indices, such as different measures of adherence to the Mediterranean diet and the dietary inflammatory index. Pain ascertainment methods and pain measurements used differed across studies. All 20 of the included studies had different study designs and statistical analysis. Of these studies, 10 reported an inverse association between adherence to a healthy dietary pattern and pain, 5 reported mixed results, and 5 reported no associations. Despite notable heterogeneity, 50% of included observational studies reported that adherence to a healthy diet, particularly the Mediterranean diet, is inversely associated with pain. Of note, the cross-sectional design of most studies precludes any causal interpretation. Moreover, limited and inconsistent evidence from longitudinal studies highlights the need for further studies.
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Affiliation(s)
- Rani R Chand
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
| | - Fiona M Blyth
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia
| | - Saman Khalatbari-Soltani
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia
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10
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Critch AL, Snow NJ, Alcock LR, Chaves AR, Buragadda S, Ploughman M. Multiple sclerosis-related heat sensitivity linked to absence of DMT prescription and subjective hand impairment but not autonomic or corticospinal dysfunction. Mult Scler Relat Disord 2023; 70:104514. [PMID: 36669245 DOI: 10.1016/j.msard.2023.104514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/28/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Heat sensitivity (HS) describes a temporary worsening of multiple sclerosis (MS) symptoms with increased body temperature. The pathophysiology may relate to central nervous system conduction deficits and autonomic dysfunction. We conducted deep clinical phenotyping of a cohort of persons with MS to identify predictors of HS. METHODS We recruited 59 MS participants with HS or No HS. Participants self-reported symptom severity (Hospital Anxiety and Depression Scale, Multiple Sclerosis Impact Scale, and fatigue visual analog scale) and underwent maximal exercise and transcranial magnetic stimulation testing to characterize autonomic and corticospinal function. We examined associations with HS using binomial logistic regression. RESULTS People with HS (36/59) had significantly greater disability, depression, fatigue, and physical and psychological functional effects of MS. They also had significantly lower corticospinal excitability but not conduction. After controlling for disease-modifying therapy (DMT), disability, and disease type, self-reported difficulty using hands in everyday tasks was significantly associated with a large increase in the odds of HS. Autonomic and corticospinal dysfunction were not associated with HS. Lack of DMT use alone was also associated with a large increase in the odds of HS. DISCUSSION Following a comprehensive assessment of plausible contributors to HS, HS was most strongly associated with lack of a DMT prescription and self-reported hand dysfunction. Surprisingly, objective measurement of autonomic and corticospinal integrity did not contribute to HS.
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Affiliation(s)
- Amber L Critch
- Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada
| | - Nicholas J Snow
- Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada
| | - Lynsey R Alcock
- Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada
| | - Arthur R Chaves
- Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada
| | - Syamala Buragadda
- Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada.
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Neate SL, Bevens W, Jelinek PL, Gray KM, Weiland TJ, Nag N, Simpson-Yap S, Jelinek GA, Yu M, Reece JC. A multiple sclerosis lifestyle behavior online course: Qualitative analysis of participants' motivations, expectations and experiences. Front Public Health 2022; 10:1022185. [PMID: 36568793 PMCID: PMC9768550 DOI: 10.3389/fpubh.2022.1022185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background Modification of lifestyle-related risk factors for multiple sclerosis (MS) has been associated with improved health outcomes when compared with standard medical management alone. Based on an existing lifestyle modification program offered as a residential workshop, the MS Online Course (MSOC) was developed to translate the workshop into an online intervention. We performed a pilot randomized controlled trial (RCT), to assess the feasibility concepts of accessibility, learnability and desirability through quantitative and qualitative analyzes. In the present study, we performed additional qualitative analyzes to explore participants' motivations, expectations, and experiences of the MSOC. This study aims to complement prior feasibility analyzes and inform recruitment strategies and course content redevelopment so that its effectiveness may be assessed by examining behavior change and health outcomes in a future larger RCT. Methods Participants were recruited via online advertisements and randomized to either: the standard care course, containing material sourced from public facing MS websites; or the intervention course, based on an evidence-based lifestyle modification program for people with MS. Course completers were invited to participate in semi-structured interviews. Within a qualitative paradigm, reflexive thematic analysis of interviews was undertaken. Results Of 31 eligible participants, 17 completed the MSOC and 14 agreed to be interviewed. Four themes were identified in this analysis: (1) "Wanting to help others" (helping through volunteering, contributing to knowledge base, spreading the word; (2) "Seeking knowledge" (confirmation of existing knowledge; obtaining new knowledge, relevant, credible information); (3) "Doing what I can to help myself" (understanding lifestyle modification, changing my lifestyle, remaining well); and (4) "Changing attitudes" (finding positivity, feeling more confident and in control). Conclusions Participants were motivated to help others through research, help themselves by improving knowledge and to find ways to better manage their MS. Expectations included obtaining credible, reliable information, to substantiate existing knowledge, and to further understand lifestyle modification. Participants' experiences included confirmation of and obtaining new knowledge, and early implementation of modified lifestyle behaviors. These insights surrounding participants' motivations, expectations and experiences will assist in recruitment strategies, course redevelopment and outcome measures for the future RCT to examine the effectiveness of the MSOC.
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Affiliation(s)
- Sandra L. Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia,*Correspondence: Sandra L. Neate
| | - William Bevens
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Pia L. Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kathleen M. Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, VIC, Australia
| | - T. J. Weiland
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nupur Nag
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia,MS Flagship, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - M. Yu
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jeanette C. Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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The Effectiveness of Cognitive-Behavioral, Mindfulness and Acceptance and Commitment Therapies to Improving the Psychological Symptoms of Patients with Multiple Sclerosis in Iran (Systematic Review and Meta-analysis). IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2022. [DOI: 10.5812/ijpbs-127590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Context: Multiple sclerosis (MS) is a neurological disease in which the myelin lining the central nervous system is damaged and often occurs between the ages of 20 and 40. In addition to loss of motor, sensory, and cognitive function, patients with MS also experience related symptoms such as depression, anxiety, stress, fatigue, and pain. Objectives: The aim of this study was to systematically and meta-analyze the effectiveness of cognitive-behavioral, mindfulness and acceptance and commitment (CMAC) therapies to improving the psychological symptoms of patients with multiple sclerosis in Iran. Methods: The study was conducted using preferred reporting items for systematic reviews and meta-analysis. This study examined articles published from the beginning until November 20, 2021 in Persian and English on cognitive and behavioral interventions performed in Iran, in order to influence psychological symptoms for people with multiple sclerosis. Articles relevant to research were screened in external (Google Scholar, PubMed, Scopus, Science Direct, Web of Science) and internal databases (Sid, Magiran, Ganj, Irandoc, Civilica). The quality of the included RCTs was assessed using the Cochrane guideline risk of bias tool. The results were expressed in terms of mean difference (MD) and the corresponding 95% confidence interval. Data analyses were performed by RevMan5.4. Results: In the first stage of the search, 792 articles were obtained. After reviewing the titles of the articles, 701 articles were discarded due to irrelevance and duplication and 91 articles remained. Finally, 21 studies were selected by reviewing the abstracts and considering the inclusion criteria. Compared with the control group, the standardized mean difference (SMD) estimate depression was 1.60 (2.27, 0.93), for anxiety 0.49 (0.80, 0.19), for stress 0.97 (1.70, 0.23) and for fatigue 0.19 (2.75, 1.25) had a positive effect; But no significant effect on pain reduction equal to 0.49 (2.21, 1.23) was not found. Conclusions: The meta-analysis in the posttest showed that the effects of CMAC were considerable on reducing depression, anxiety, stress, and fatigue, but the effects were not notable for pain mitigation. Future high quality studies with follow-up evaluations are needed to support the effects of CMAC on reducing symptoms in people with multiple sclerosis and to evaluate the interventional features that enhance and maintain the effects.
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13
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Bahmani B, Mehraban S, Carnero Contentti E, Azkhosh M, Khanjani M, Azimian M. Relationship of coping strategies with mood symptoms, disease related characteristics and demographic variables in patients with multiple sclerosis: A systematic review study. Mult Scler Relat Disord 2022; 67:104163. [PMID: 36126537 DOI: 10.1016/j.msard.2022.104163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/13/2022] [Accepted: 09/05/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE the aim of this systematic review was to summarize the coping strategies utilized by people with multiple sclerosis (pwMS) and the association of these strategies with mood symptoms, quality of life, fatigue and disability in pwMS. METHODS search in the literature was performed across electronic databases of PubMed, Web of Science, and Scopus. No time constraint was applied for searching across the databases. Manual search was also performed on the list of references of the retrieved papers. Two authors independently evaluated the retrieved citations based on predetermined inclusion criteria in two screening stages. This systematic review followed Joanna Briggs Institute (JBI) guidelines for cross-sectional research. The findings related to the coping patterns against MS as well as the relationship between the patterns and MS symptoms were extracted and synthesized. FINDINGS A total of 2390 records were identified. After removing duplicates and based on screening, 39 papers met the eligibility criteria for qualitative synthesis, and they were evaluated in terms of quality of study. When comparing genders, women used more religious coping, social support seeking, and positive coping compared to men. Depression and anxiety were associated with maladaptive and emotion-oriented coping strategies. The patients who used positive and problem solving oriented coping strategies had a better score of quality of life. Disability and fatigue were associated with applying avoidance and maladaptive coping strategies. CONCLUSION the findings of this review suggest that understanding the relationship between coping strategies and quality of life as well as the symptoms related to the disease is important to understand development of psychological interventions adopted by specialists to support these patients.
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Affiliation(s)
- Bahman Bahmani
- Department of counselling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shafigh Mehraban
- Department of counselling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | | | - Manouchehr Azkhosh
- Department of counselling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammadsaeed Khanjani
- Department of counselling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mojtaba Azimian
- Department of Clinical Science, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Mabrouk M, El Ayed M, Démosthènes A, Aissouni Y, Aouani E, Daulhac-Terrail L, Mokni M, Bégou M. Antioxidant effect of grape seed extract corrects experimental autoimmune encephalomyelitis behavioral dysfunctions, demyelination, and glial activation. Front Immunol 2022; 13:960355. [PMID: 36059517 PMCID: PMC9428676 DOI: 10.3389/fimmu.2022.960355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/15/2022] [Indexed: 12/01/2022] Open
Abstract
Background and purpose Multiple sclerosis (MS), a multifactorial autoimmune disease of the central nervous system (CNS), is characterized by demyelination and chronic inflammation, as well as axonal and neuronal loss. There is no cure for MS, and despite a significant improvement in the therapeutic management of patients during the last 20 years, some symptoms are still resistant to treatment, and the evolution of the disease to progressive form seems still ineluctable. The etiology of MS is complex and still not fully understood. However, inflammation is a major driver of physiopathology and oxidative stress contributes to CNS lesions and promotes existing inflammatory response. Plant polyphenols are endowed with many therapeutic benefits through alleviating oxidative stress and inflammation, thus providing neuroprotection in MS. We presently evaluated the curative effect of grape seed extract (GSE) in an experimental autoimmune encephalomyelitis (EAE) mouse model of MS. Experimental approach Six-week-old C57Bl/6J females were subjected to the EAE paradigm (using myelin oligodendrocyte glycoprotein peptide fragment (35-55), complete Freund’s adjuvant, and pertussis toxin) and then chronically treated with GSE from day 10 to day 30 post-induction. Clinical score and body weight were monitored daily, while evaluation of sensitive, motor, cognitive, and anxiety-related behaviors was performed weekly. Then, the GSE effect was evaluated on whole brain and spinal cord samples through the evaluation of oxidative stress damage, antioxidant capacities, myelin alteration, astroglial and microglial proliferation, and sirtuin expression. Key results Grape seed extract curative chronic treatment corrected the clinical course of EAE, as well as the mechanical hypersensitivity, and avoided the development of EAE mouse thermal cold allodynia. The neuropathological evaluation showed that GSE reduced oxidative stress in the brain and spinal cord by decreasing the lipid and protein oxidation through correction of the three main antioxidant enzyme activities, namely, superoxide dismutase, catalase, and glutathione peroxidase, as well as restoring normal myelin protein expression and correcting microglial and astroglial protein overexpression and sirtuin downregulation. Conclusion and implications These data strongly support GSE as an effective therapeutic approach in MS treatment.
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Affiliation(s)
- Maha Mabrouk
- Université Clermont Auvergne, INSERM 1107, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France
- Laboratoire de substances bioactives, Centre de Biotechnologie, Technopole de Borj Cedria, Hammam-Lif, Tunisia
- Faculté des Sciences de Tunis (FST), Université de Tunis el Manar (UTM), Tunis, Tunisia
| | - Mohamed El Ayed
- Laboratoire de substances bioactives, Centre de Biotechnologie, Technopole de Borj Cedria, Hammam-Lif, Tunisia
- Faculté des Sciences de Tunis (FST), Université de Tunis el Manar (UTM), Tunis, Tunisia
| | - Amélie Démosthènes
- Université Clermont Auvergne, INSERM 1107, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France
| | - Youssef Aissouni
- Université Clermont Auvergne, INSERM 1107, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France
| | - Ezzedine Aouani
- Laboratoire de substances bioactives, Centre de Biotechnologie, Technopole de Borj Cedria, Hammam-Lif, Tunisia
- Faculté des Sciences de Tunis (FST), Université de Tunis el Manar (UTM), Tunis, Tunisia
| | - Laurence Daulhac-Terrail
- Université Clermont Auvergne, INSERM 1107, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France
| | - Meherzia Mokni
- Laboratoire de substances bioactives, Centre de Biotechnologie, Technopole de Borj Cedria, Hammam-Lif, Tunisia
- Faculté des Sciences de Tunis (FST), Université de Tunis el Manar (UTM), Tunis, Tunisia
| | - Mélina Bégou
- Université Clermont Auvergne, INSERM 1107, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France
- *Correspondence: Mélina Bégou,
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Démosthènes A, Sion B, Giraudet F, Moisset X, Daulhac L, Eschalier A, Bégou M. In-Depth Characterization of Somatic and Orofacial Sensitive Dysfunctions and Interfering-Symptoms in a Relapsing-Remitting Experimental Autoimmune Encephalomyelitis Mouse Model. Front Neurol 2022; 12:789432. [PMID: 35111128 PMCID: PMC8801881 DOI: 10.3389/fneur.2021.789432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Among the many symptoms (motor, sensory, and cognitive) associated with multiple sclerosis (MS), chronic pain is a common disabling condition. In particular, neuropathic pain symptoms are very prevalent and debilitating, even in early stages of the disease. Unfortunately, chronic pain still lacks efficient therapeutic agents. Progress is needed (i) clinically by better characterizing pain symptoms in MS and understanding the underlying mechanisms, and (ii) preclinically by developing a more closely dedicated model to identify new therapeutic targets and evaluate new drugs. In this setting, new variants of experimental autoimmune encephalomyelitis (EAE) are currently developed in mice to exhibit less severe motor impairments, thereby avoiding confounding factors in assessing pain behaviors over the disease course. Among these, the optimized relapsing-remitting EAE (QuilA-EAE) mouse model, induced using myelin oligodendrocyte glycoprotein peptide fragment (35–55), pertussis toxin, and quillaja bark saponin, seems very promising. Our study sought (i) to better define sensitive dysfunctions and (ii) to extend behavioral characterization to interfering symptoms often associated with pain during MS, such as mood disturbances, fatigue, and cognitive impairment, in this optimized QuilA-EAE model. We made an in-depth characterization of this optimized QuilA-EAE model, describing for the first time somatic thermal hyperalgesia associated with mechanical and cold allodynia. Evaluation of orofacial pain sensitivity showed no mechanical or thermal allodynia. Detailed evaluation of motor behaviors highlighted slight defects in fine motor coordination in the QuilA-EAE mice but without impact on pain evaluation. Finally, no anxiety-related or cognitive impairment was observed during the peak of sensitive symptoms. Pharmacologically, as previously described, we found that pregabalin, a treatment commonly used in neuropathic pain patients, induced an analgesic effect on mechanical allodynia. In addition, we showed an anti-hyperalgesic thermal effect on this model. Our results demonstrate that this QuilA-EAE model is clearly of interest for studying pain symptom development and so could be used to identify and evaluate new therapeutic targets. The presence of interfering symptoms still needs to be further characterized.
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Affiliation(s)
- Amélie Démosthènes
- Université Clermont Auvergne, Inserm, Neuro-Dol, Faculté de Pharmacie, Faculté de Médecine, Institut Analgesia, BP38, Clermont-Ferrand, France
| | - Benoît Sion
- Université Clermont Auvergne, Inserm, Neuro-Dol, Faculté de Pharmacie, Faculté de Médecine, Institut Analgesia, BP38, Clermont-Ferrand, France
| | - Fabrice Giraudet
- Université Clermont Auvergne, Inserm, Neuro-Dol, Faculté de Pharmacie, Faculté de Médecine, Institut Analgesia, BP38, Clermont-Ferrand, France
| | - Xavier Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Faculté de Médecine, Institut Analgesia, BP38, Clermont-Ferrand, France
| | - Laurence Daulhac
- Université Clermont Auvergne, Inserm, Neuro-Dol, Faculté de Pharmacie, Faculté de Médecine, Institut Analgesia, BP38, Clermont-Ferrand, France
| | - Alain Eschalier
- Université Clermont Auvergne, Inserm, Neuro-Dol, Faculté de Pharmacie, Faculté de Médecine, Institut Analgesia, BP38, Clermont-Ferrand, France
| | - Mélina Bégou
- Université Clermont Auvergne, Inserm, Neuro-Dol, Faculté de Pharmacie, Faculté de Médecine, Institut Analgesia, BP38, Clermont-Ferrand, France
- *Correspondence: Mélina Bégou
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16
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Weinstein SM, Reilly E, Garland N, Zimmerman V, Jacobs D. Impact of a Virtual Wellness Program on Quality of Life Measures for Patients Living With Multiple Sclerosis During the COVID-19 Pandemic. Int J MS Care 2022; 24:282-286. [PMID: 36545649 PMCID: PMC9749834 DOI: 10.7224/1537-2073.2021-134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) were vulnerable to the effects of physical inactivity during the COVID-19 pandemic. As patients returned to in-person visits, providers reported seeing increased weakness, balance issues, falls, worsening pain, and spasticity. Social isolation also contributed to increased stress, depression, and anxiety. This study explored whether attending virtual wellness programs was associated with improvements in standard quality of life questionnaire scores for patients with MS. METHODS The purposive convenience sample consisted of 43 patients in the treatment group and 28 in the control group. Patients in the treatment group attended 2 monthly programs for 6 months and completed a demographic questionnaire, the 36-Item Short Form Health Survey (SF-36), the Modified Fatigue Impact Scale, and the Medical Outcomes Study Pain Effects Scale (PES). Patients requested additional topics, resulting in 5 additional programs. The control group consisted of patients who chose not to attend the programs but agreed to complete the questionnaires. RESULTS In comparing questionnaire responses (6 months minus baseline) among the participants in the treatment group, an association was found between higher meeting attendance and improvements in emotional well-being (P = .038), pain on the PES (P = .011), mindfulness on the SF-36 pain scale (P = .0472), and exercise on the PES (P = .0115). CONCLUSIONS The results of this study suggest that a virtual wellness program may provide beneficial emotional support, physical exercise, and health promotion activities resulting in improved quality of life in people with MS. In addition, mindfulness and exercise programs may be beneficial in pain management.
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Affiliation(s)
- Sarah M. Weinstein
- The Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA (SMW)
| | | | - Nora Garland
- From the Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA (DJ, NG, VZ)
| | - Vanessa Zimmerman
- From the Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA (DJ, NG, VZ)
| | - Dina Jacobs
- From the Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA (DJ, NG, VZ)
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Palukuru S, Patil SS, Nagarathna R, Singh A, Nibedita KS. Content Validity of an Integrated Yoga Module for Practice During Remission in Relapsing-Remitting Multiple Sclerosis Patients. Ann Neurosci 2021; 28:29-38. [PMID: 34733052 PMCID: PMC8558981 DOI: 10.1177/09727531211023754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Some investigations point to the beneficial effects of yoga in alleviating
the motor and cognitive dysfunctions in multiple sclerosis (MS) patients by
using varying combinations of physical, breathing, and meditative practices
of yoga. There is a need for a validated yoga module with a holistic
approach that can be used as a standardized protocol by researchers and
therapists. Purpose: To develop and validate an integrated yoga module for practice in
relapsing–remitting MS patients to improve their quality of life. Methods: We did a thorough review of the literature for the development of the yoga
module. We formed an expert group with 24 experts and a neurologist and used
two rounds of interactive Delphi method to combine their opinion to obtain
content validity of the module through online structured questionnaire
prepared for the purpose on a Google Form. We incorporated all suggestions
obtained by the experts. The final module (60 min per session, twice a day,
five days per week) included warm-up exercises, customized asanas,
relaxation techniques, and OM meditation. Advice on yogic diet and
discussion using yogic concepts for stress management also form a part of
the holistic approach to yoga lifestyle modification. Results: Analysis divulged that 30 out of 39 practices exhibited a content validity
ratio value greater than or equal to 0.42. Conclusion: The study has shown good content validity of the integrated yoga module.
Future clinical studies are being planned to rule the feasibility and
reliability of this module.
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Affiliation(s)
- Sreedhar Palukuru
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - Suchitra S Patil
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - R Nagarathna
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - Amit Singh
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - K S Nibedita
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
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18
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Scherder RJ, Prins AJ, van Dorp MJ, van Klaveren C, Cornelisz I, Killestein J, Weinstein H. Pain, cognition and disability in advanced multiple sclerosis. Scand J Pain 2021; 21:754-765. [PMID: 34469640 DOI: 10.1515/sjpain-2021-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In patients with multiple sclerosis (MS), a relationship between physical disability and pain has been observed. In addition a relationship between physical disability and cognition in MS has been suggested. However, cognitive functions and pain appear not to be correlated in MS patients. Therefore, we examined whether a possible relationship between pain and cognitive functioning may exist, and if so, if such a relationship is mediated by physical disability. METHODS Forty-five MS patients with chronic pain, and in an advanced stage of the disease were included. Physical disabilities were assessed by the Expanded Disability Status Scale (EDSS). Episodic memory was assessed by means of the Eight Words test, and Face and Picture Recognition. Executive functions (EF) were examined by Digit Span Backward for working memory, and the Rule Shift Cards and Category Fluency test for cognitive flexibility. Pain Intensity and Pain Affect were assessed by means of visual analogue scales and one verbal pain scale and mood (depression, anxiety) by the Beck Depression Inventory and the Symptom Check List (SCL-90). The research questions were analyzed by means of regression analyses and the Sobel test for mediation. RESULTS A significant relationship was found between Pain Affect and EF, but that relationship was not mediated by physical disabilities (EDSS). In addition, Pain Intensity and EF showed a significant relationship but only in combination with physical disabilities (EDSS). Finally, mood was related to pain affect. DISCUSSION The findings suggest that the lower the EF, exclusively or in combination with more physical disabilities, the more the patient may suffer from pain. IMPLICATIONS The more one is cognitively and physically impaired, the more one might suffer from pain, and, the less one is able to communicate pain. The latter could put MS patients at risk for underdiagnosing and undertreatment of pain.
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Affiliation(s)
- Rogier J Scherder
- Medical Faculty, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | | | | | - Chris van Klaveren
- Department of Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ilja Cornelisz
- Department of Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Henry Weinstein
- Department of Neurology, OLVG location West, Amsterdam, The Netherlands
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19
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Marck CH, Probst Y, Chen J, Taylor B, van der Mei I. Dietary patterns and associations with health outcomes in Australian people with multiple sclerosis. Eur J Clin Nutr 2021; 75:1506-1514. [PMID: 33531638 DOI: 10.1038/s41430-021-00864-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/21/2020] [Accepted: 01/12/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND/OBJECTIVES Associations between patterns of food intake and health in people with multiple sclerosis (MS) are of increasing global interest; however, Australian data are lacking. This study aimed to assess the dietary habits and associations with health outcomes of Australians with MS. SUBJECTS/METHODS This cross-sectional study used 2016 survey data from the Australian MS Longitudinal Study, including the Dietary Habits Questionnaire, Hospital Anxiety and Depression Scale, Assessment of Quality of Life, Fatigue Severity Scale, Patient-Determined Disease Steps Scale and 13 MS symptoms scales. Regression models were constructed using directed acyclic graphs. RESULTS Almost all (94.3%) of the 1490 participants reported making an effort to eating healthy with 21.2% following one or more specific diets, although often not strictly. Overall, 7.9% reported not eating meat, 8.1% reported not consuming dairy, and 4.0% consumed neither food group. A healthier diet score was associated with better mental, physical and total quality of life, and lower depression, and pain scores, and fewer cognition, vision and bowel symptoms. Higher reported fibre, fruit, vegetable and healthy fat scores were positively associated with most health outcomes. CONCLUSIONS Healthier overall diet scores and higher fibre, fruit and vegetable scores were associated with better health outcomes in this sample of Australians adults with MS. However, the proportion of participants avoiding dairy and meat, or adhering to a specific MS diet was much lower than previously reported. Prospective dietary studies are needed to further understand whether dietary change is feasible and affects health outcomes over time.
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Affiliation(s)
- Claudia H Marck
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Yasmine Probst
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Jing Chen
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
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20
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Ondek K, Nasirishargh A, Dayton JR, Nuño MA, Cruz-Orengo L. Strain and sex differences in somatosensation and sociability during experimental autoimmune encephalomyelitis. Brain Behav Immun Health 2021; 14:100262. [PMID: 34589768 PMCID: PMC8474462 DOI: 10.1016/j.bbih.2021.100262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 12/01/2022] Open
Abstract
Multiple Sclerosis (MS) is an immune-mediated disease that results in major locomotor deficits. However, recent studies have revealed that fatigue, slow processing speed, and memory impairment are the top variables impacting employment status for MS patients. These suggest that cognitive effects may have a greater impact on productivity, lifestyle, and quality of life than do disease-related motor deficits. However, these debilitating non-locomotive effects have been largely overlooked in rodent models of the disease, such as experimental autoimmune encephalomyelitis (EAE). We hypothesized that murine EAE can also be used to assess non-locomotive dysfunctions (mood, sociability, muscle strength, and balance), as well as potential biases in these dysfunctions due to sex and/or strain. We actively immunized male and female C57BL/6 (B6) and SJL mice for EAE and evaluated their performance on the Deacon's weight grip test, Kondziela's inverted screen test, Hall's rope grip test, manual von Frey test for somatic nociception, and a three-chamber social preference paradigm. We hypothesized that EAE progression is associated with changes in muscle strength, balance, pain, and sociability and that these variations are linked to sex and/or strain. Our results indicate that strain but not sex influenced differences in muscle strength and balance during EAE, and both sex and strain have an impact on mechanical nociception, regardless of EAE disease status. Furthermore, both sex and strain had complex effects on differences in sociability. In conclusion, testing these additional modalities during EAE helps to unveil other signs and symptoms that could be used to determine the efficacy of a drug or treatment in the modulation of a MS-like behavior.
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Affiliation(s)
- Katelynn Ondek
- University of California, Davis. Department of Anatomy, Physiology & Cell Biology, School of Veterinary Medicine, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
| | - Aida Nasirishargh
- University of California, Davis. Department of Anatomy, Physiology & Cell Biology, School of Veterinary Medicine, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
| | - Jacquelyn R. Dayton
- University of California, Davis. Department of Anatomy, Physiology & Cell Biology, School of Veterinary Medicine, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
| | - Miriam A. Nuño
- University of California, Davis. Department of Public Health, Division of Biostatistics, School of Medicine, Public Health/Medical Sciences Bldg. 1-C, Davis, CA 95616, USA
| | - Lillian Cruz-Orengo
- University of California, Davis. Department of Anatomy, Physiology & Cell Biology, School of Veterinary Medicine, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
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21
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Bevens W, Gray K, Neate SL, Nag N, Weiland TJ, Jelinek GA, Simpson-Yap S. Characteristics of mHealth app use in an international sample of people with multiple sclerosis. Mult Scler Relat Disord 2021; 54:103092. [PMID: 34246024 DOI: 10.1016/j.msard.2021.103092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/25/2021] [Accepted: 06/13/2021] [Indexed: 11/25/2022]
Abstract
The management of multiple sclerosis (MS) has progressed significantly with the emergence of mHealth technologies. Uptake of mHealth apps amongst people with MS, and clinical and demographic characteristics of mHealth adopters is unknown outside North America. Participants of the HOLISM study were queried about their mHealth apps use. We summarize mHealth app usage, and clinical and demographic characteristics of mHealth app adopters using descriptive statistics. Overall, 3.1% of respondents reported using an mHealth app, most of whom were located in Australasia and North America. This study provides insight regarding mHealth app usage within a large international cohort of people with MS.
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Affiliation(s)
- W Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - K Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Australia
| | - S L Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - N Nag
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - T J Weiland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - G A Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - S Simpson-Yap
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmania, Australia
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22
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Salarvand S, Heidari ME, Farahi K, Teymuri E, Almasian M, Bitaraf S. Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler J Exp Transl Clin 2021; 7:20552173211022779. [PMID: 34188950 PMCID: PMC8209836 DOI: 10.1177/20552173211022779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background Fatigue and pain are prevalent symptoms of multiple sclerosis (MS) and frequent complaint in MS patients, which reduce their quality of life. This study aimed to assess the effect of massage therapy on pain and fatigue in MS Patients. Method The original and Persian databases were searched included PubMed, web of science, embase, ovid, scopus, and the Cochrane Library, SID, and Iranedex from inception to November 2020. Studies that reported the effect of massage on fatigue and pain were included. Two investigators extracted all relevant data, independently. For deriving analysis, mean difference (MD) and standardized mean difference (SMD) were used. Result Ten studies were eligible acoording criteria. The effect of massage on fatigue showed significant improvement (-1.62; 95% CL -2.40, -0.83; p < .00001), also results of the systematic review showed a significant reduction in pain severity. Conclusion Massage as a complementary and non-pharmacological therapy might have been associated with alleviating fatigue and pain in M.S. patients. Based on the current study, massage intervention for MS patients could have possible clinical value for palliating pain and fatigue and improving quality of life; however, this matter needs further and more significant trial studies.
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Affiliation(s)
- Shahin Salarvand
- Hepatitis Research Center, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Eghbal Heidari
- Student Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Farahi
- Student Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Teymuri
- Student Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Almasian
- Department of the English Language, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Saeid Bitaraf
- Department of Epidemiology and Biostatistics, Iran University of Medical Sciences, Tehran, Iran
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23
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Knowles LM, Phillips KM, Herring TE, Alschuler KN, Jensen MP, Turner AP, Ehde DM. Pain Intensity and Pain Interference in People With Progressive Multiple Sclerosis Compared With People With Relapsing-Remitting Multiple Sclerosis. Arch Phys Med Rehabil 2021; 102:1959-1964. [PMID: 34048792 DOI: 10.1016/j.apmr.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe pain intensity and interference in people with progressive multiple sclerosis (MS), compare these with people with relapsing-remitting multiple sclerosis (RRMS), and identify common and unique factors associated with pain intensity in people with progressive MS and RRMS. DESIGN Observational, cross-sectional analysis using baseline data from a longitudinal survey on quality of life in participants with MS. SETTING Community. PARTICIPANTS A total of 573 adults with MS (N=573; progressive MS, n=142; RRMS, n=431). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Average pain intensity was measured by an 11-point numeric rating scale, and pain interference was measured by the Patient-Reported Outcomes Measurement Information System Pain Interference Short Form. RESULTS Participants with progressive MS reported moderate average pain intensity (3.22±2.50) and elevated pain interference (T score of 55.55±9.13). They did not differ significantly from those with RRMS in average pain intensity or pain interference. Common factors associated with higher average pain intensity were more severe disability, lower education level, unemployment, and current smoking. In those with progressive MS, older age was associated with lower average pain intensity. CONCLUSIONS Pain intensity and interference are similar across MS types. In addition to assessing and treating pain, it is important to screen for modifiable pain-related factors, such as smoking cessation, in this population.
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Affiliation(s)
- Lindsey M Knowles
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Multiple Sclerosis Center of Excellence-West, Veterans Administration Puget Sound Health Care System, Seattle Division, Seattle, WA.
| | - Kala M Phillips
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Tracy E Herring
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Department of Neurology, University of Washington School of Medicine, Seattle, WA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Aaron P Turner
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Multiple Sclerosis Center of Excellence-West, Veterans Administration Puget Sound Health Care System, Seattle Division, Seattle, WA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
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24
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Longitudinal prevalence and determinants of pain in multiple sclerosis: results from the German National Multiple Sclerosis Cohort study. Pain 2021; 161:787-796. [PMID: 32197038 DOI: 10.1097/j.pain.0000000000001767] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pain is frequent in multiple sclerosis (MS) and includes different types, with neuropathic pain (NP) being most closely related to MS pathology. However, prevalence estimates vary largely, and causal relationships between pain and biopsychosocial factors in MS are largely unknown. Longitudinal studies might help to clarify the prevalence and determinants of pain in MS. To this end, we analyzed data from 410 patients with newly diagnosed clinically isolated syndrome or relapsing-remitting MS participating in the prospective multicenter German National MS Cohort Study (NationMS) at baseline and after 4 years. Pain was assessed by self-report using the PainDETECT Questionnaire. Neuropsychiatric assessment included tests for fatigue, depression, and cognition. In addition, sociodemographic and clinical data were obtained. Prevalence of pain of any type was 40% and 36% at baseline and after 4 years, respectively, whereas prevalence of NP was 2% and 5%. Pain of any type and NP were both strongly linked to fatigue, depression, and disability. This link was even stronger after 4 years than at baseline. Moreover, changes in pain, depression, and fatigue were highly correlated without any of these symptoms preceding the others. Taken together, pain of any type seems to be much more frequent than NP in early nonprogressive MS. Moreover, the close relationship between pain, fatigue, and depression in MS should be considered for treatment decisions and future research on a possible common pathophysiology.
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25
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Han A. Mindfulness- and Acceptance-Based Interventions for Symptom Reduction in Individuals With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2021; 102:2022-2031.e4. [PMID: 33812883 DOI: 10.1016/j.apmr.2021.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/12/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the effects of mindfulness- and acceptance-based interventions (MABIs) on reducing symptoms in individuals with multiple sclerosis (MS). DATA SOURCES A comprehensive search was conducted within the PubMed, CINAHL, PsycINFO, and SCOPUS databases for articles published from inception to July 3, 2020. STUDY SELECTION Randomized controlled trials (RCTs) were included if MABIs were provided to individuals with MS exclusively, with reported pre-and posttest results in symptoms of depression, anxiety, stress, fatigue, or pain. DATA EXTRACTION Characteristics of the included RCTs and data for meta-analysis were extracted. The quality of the included RCTs was assessed using the Cochrane Collaboration risk of bias tool. DATA SYNTHESIS A random effects model with the inverse variance method was used with effect size reported as standardized mean difference. Heterogeneity was assessed using the I2 statistic. RESULTS Twenty-three RCTs met the eligibility criteria. Meta-analyses found large effects of MABIs on reducing depressive symptoms, anxiety, stress, and pain, as well as a moderate effect of MABIs on reducing fatigue at the immediate posttest. Large effects of MABIs on reducing depressive symptoms, anxiety, and stress at follow-up were also found, whereas a moderate effect on reducing fatigue was found at follow-up. There was no significant effect of MABIs on reducing pain at follow-up. CONCLUSIONS Fewer studies were included in meta-analyses for pain at the immediate posttest and follow-up and stress and fatigue at follow-up. The overall risk of bias was unclear. Future high-quality studies with follow-up evaluations are needed to support effects of MABIs on reducing symptoms in individuals with MS and examine intervention features that increase and maintain effects.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL.
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26
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Jones CD, Motl R, Sandroff BM. Depression in multiple sclerosis: Is one approach for its management enough? Mult Scler Relat Disord 2021; 51:102904. [PMID: 33780807 DOI: 10.1016/j.msard.2021.102904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/18/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Major depression disorder (MDD) and severe depression symptoms are highly prevalent in multiple sclerosis (MS). Depression can worsen symptoms of MS and is associated with significantly reduced quality of life and increased risk of suicide. Currently, there is no gold-standard, single treatment available for depression in MS. Pharmacotherapy, cognitive behavior therapy (CBT), and exercise training individually are moderately, yet incompletely, efficacious for managing depression in the general population and MS. PURPOSE This review provides an overview of evidence from meta-analyses and systematic reviews for current treatments of depression in persons with MS. This review further develops the rationale for using a combinatory treatment approach in persons with MS. METHODS We performed a narrative review of meta-analyses and systematic reviews regarding the current state of evidence for the three most common treatments of depression in persons with MS (i.e., antidepressant medication, cognitive-behavior therapy, and exercise training). We provide a concise assessment of the overall effect of these treatments on depression in the general population and then persons with MS. We further note short-comings of research on these treatments for depression. CONCLUSION There is no single, gold-standard treatment for depression in MS, and we proposed that combinatory treatments should be considered for the management of depression in MS. However, there is a paucity of evidence for the use of combinatory therapy on depression and its outcomes in persons with MS, and this supports direct examination of the feasibility and efficacy of such combinatory approaches for MDD in MS.
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Affiliation(s)
- C Danielle Jones
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, AL, United States.
| | - Robert Motl
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, AL, United States
| | - Brian M Sandroff
- Kessler Foundation, Center for Neuropsychology and Neuroscience, West Orange, NJ, United States
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27
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Gil-González I, Martín-Rodríguez A, Conrad R, Pérez-San-Gregorio MÁ. Quality of life in adults with multiple sclerosis: a systematic review. BMJ Open 2020; 10:e041249. [PMID: 33257490 PMCID: PMC7705559 DOI: 10.1136/bmjopen-2020-041249] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE In recent years, quality of life (QoL) in multiple sclerosis (MS) has been gaining considerable importance in clinical research and practice. Against this backdrop, this systematic review aimed to provide a broad overview of clinical, sociodemographic and psychosocial risk and protective factors for QoL in adults with MS and analyse psychological interventions for improving QoL. METHOD The literature search was conducted in the Scopus, Web of Science and ProQuest electronic databases. Document type was limited to articles written in English, published from January 1, 2014, to January 31, 2019. Information from the selected articles was extracted using a coding sheet and then qualitatively synthesised. RESULTS The search identified 4886 records. After duplicate removal and screening, 106 articles met the inclusion and exclusion criteria for qualitative synthesis and were assessed for study quality. Disability, fatigue, depression, cognitive impairment and unemployment were consistently identified as QoL risk factors, whereas higher self-esteem, self-efficacy, resilience and social support proved to be protective. The review analysed a wide spectrum of approaches for QoL psychological intervention, such as mindfulness, cognitive behavioural therapy, self-help groups and self-management. The majority of interventions were successful in improving various aspects of QoL. CONCLUSION Adequate biopsychosocial assessment is of vital importance to treat risk and promote protective factors to improve QoL in patients with MS in general care practice.
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Affiliation(s)
- Irene Gil-González
- Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | | | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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28
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Zucchella C, Mantovani E, De Icco R, Tassorelli C, Sandrini G, Tamburin S. Non-invasive Brain and Spinal Stimulation for Pain and Related Symptoms in Multiple Sclerosis: A Systematic Review. Front Neurosci 2020; 14:547069. [PMID: 33328843 PMCID: PMC7715002 DOI: 10.3389/fnins.2020.547069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Neuropathic and nociceptive pain frequently affect patients with multiple sclerosis (MS), with a prevalence close to 90% and significant impact on general health and quality of life. Pharmacological strategies are widely used to treat pain in MS, but their effectiveness and side-effects are controversial. Among non-pharmacological treatments for pain, non-invasive brain and spinal stimulation (NIBSS) has shown promising preliminary results in MS. Objective: Systematic review to investigate the effect of NIBSS for the management of pain in MS. Methods: A literature search using Pubmed, Science Direct and Web of Science was conducted from databases inception to February 21, 2020 for studies assessing the analgesic effect of NIBSS on pain in MS. Results: A total of 279 records were title- and abstract-screened, nine were assessed for full text and included. The NIBSS techniques explored were transcranial direct current stimulation (N = 5), transcranial magnetic stimulation (N = 2), transcranial random noise stimulation (N =1), transcutaneous spinal direct current stimulation (N = 1). The targets were the primary motor cortex (M1; N = 4), the left dorsolateral pre-frontal cortex (DLPFC; N = 3), the spinal cord (N = 1), unspecified brain target (N = 1). The study designs were randomized (N = 7), open label (N = 1), single case report (N = 1). Despite the differences in study design, target and NIBSS technique that impeded a meta-analysis, all the studies converge in showing a significant improvement of pain after active NIBSS with less consistent effects on other symptoms of the pain-related cluster (depression, fatigue, cognition) and quality of life. Conclusions: Excitatory NIBSS over M1, left DLPFC and spinal cord appear to be the most effective protocols for pain in MS. Open questions include the use of neurophysiological or neuroimaging surrogate outcome measures, the stratification of patients according to the clinical profiles and underlying pathogenetic mechanisms and the combination of NIBSS to pharmacological treatment, neurorehabilitation, or psychotherapy to improve the clinical effect. The duration of the effect to NIBSS and the feasibility and efficacy of telemedicine NIBSS protocols are other open key questions.
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Affiliation(s)
- Chiara Zucchella
- Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto De Icco
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giorgio Sandrini
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stefano Tamburin
- Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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29
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Heitmann H, Andlauer TFM, Korn T, Mühlau M, Henningsen P, Hemmer B, Ploner M. Fatigue, depression, and pain in multiple sclerosis: How neuroinflammation translates into dysfunctional reward processing and anhedonic symptoms. Mult Scler 2020; 28:1020-1027. [PMID: 33179588 PMCID: PMC9131410 DOI: 10.1177/1352458520972279] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fatigue, depression, and pain affect the majority of multiple sclerosis
(MS) patients, which causes a substantial burden to patients and
society. The pathophysiology of these symptoms is not entirely clear,
and current treatments are only partially effective. Clinically, these
symptoms share signs of anhedonia, such as reduced motivation and a
lack of positive affect. In the brain, they are associated with
overlapping structural and functional alterations in areas involved in
reward processing. Moreover, neuroinflammation has been shown to
directly impede monoaminergic neurotransmission that plays a key role
in reward processing. Here, we review recent neuroimaging and
neuroimmunological findings, which indicate that dysfunctional reward
processing might represent a shared functional mechanism fostering the
symptom cluster of fatigue, depression, and pain in MS. We propose a
framework that integrates these findings with a focus on monoaminergic
neurotransmission and discuss its therapeutic implications,
limitations, and perspectives.
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Affiliation(s)
- Henrik Heitmann
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany/TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany/Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Till F M Andlauer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Korn
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany/ Department of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany/Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany/TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany/Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Markus Ploner
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany/TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
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30
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Pain Characteristics and Associations with Quality of Life in Patients with Multiple Sclerosis in Lithuania. ACTA ACUST UNITED AC 2020; 56:medicina56110596. [PMID: 33171619 PMCID: PMC7695204 DOI: 10.3390/medicina56110596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/29/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022]
Abstract
Background and objectives: Even though pain in multiple sclerosis (MS) patients is common and possibly associated with reduced quality of life, its exact prevalence and characteristics remain vaguely understood. We aimed to estimate the true extent of pain and its associations with quality of life in Lithuanian MS patients and to compare this data with that of a control group. Materials and Methods: Data were collected prospectively at the Department of Neurology, Lithuanian University of Health Sciences Kaunas Clinics. A face-to-face structured interview and a questionnaire were used to collect demographic and clinical data of the MS (n = 120) and control (n = 120) groups. The Expanded Disability Status Scale (EDSS) was used to quantify disability in the MS group. Scores ≥4/10 in the Douleur Neuropathique 4 questionnaire were classified as neuropathic pain. Patients were evaluated using the anxiety and depression subsets of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D), the physical and mental component subsets of the Short Form-12 questionnaire (PSC-12 and MSC-12). Results: The MS and control groups did not differ in pain prevalence (76.7% vs. 65.9%, p = 0.064) or intensity. Lhermitte sign, lower limb, and face pain were more common in the MS group, whereas subjects in the control group were more often affected by lower back, neck, and joint pain. Neuropathic pain and pain lasting longer than 2 years were more common among pain-affected MS patients than among controls. MS patients with pain had higher EDSS, HADS-D, and HADS-A and lower PSC-12 scores than those without pain; however, no difference was found regarding the duration of MS or age. Males with MS and pain had higher MSC-12 and HADS-D scores in comparison to the same subset of females. Conclusions: Pain affects approximately three out of four patients with MS in Lithuania and is negatively associated with the mental and physical aspects of quality of life.
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31
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Rommer PS, Ellenberger D, Hellwig K, Haas J, Pöhlau D, Stahmann A, Zettl UK. Relapsing and progressive MS: the sex-specific perspective. Ther Adv Neurol Disord 2020; 13:1756286420956495. [PMID: 33029201 PMCID: PMC7521047 DOI: 10.1177/1756286420956495] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative
disease whose aetiology is not fully understood. The female sex
is clearly predominant, with a sex ratio between 2 and 3. In
primary progressive MS the sex ratio almost balances out. Since
the age at onset is higher for patients with progressive onset
(POMS) than for relapsing onset (ROMS), it can be hypothesized
that the age at onset is a decisive factor for the sex
ratio. Methods: To address this aspect, we compare clinical and demographic data
between females and males for the different disease courses
within the population of the German MS Register by the German MS
Society. Only patients with complete details in mandatory data
items and a follow-up visit since 01. Jan 2018 were
included. Results: A total of 18,728 patients were included in our analyses, revealing
a female-to-male ratio of 2.6 (2.7 for patients with ROMS and
1.3 for POMS). The age at diagnosis is higher in patients with
POMS (43.3 and 42.3 years for females and males
versus 32.1 and 33.2 years,
respectively). Females irrespective of disease course are
statistically significantly more often affected by cognitive
impairment (POMS: p = 0.013, ROMS:
p = 0.001) and depression (POMS:
p = 0.002, ROMS: 0.001) and suffer more
often from pain (POMS and ROMS: p < 0.001).
Fatigue is significantly more often seen in females with ROMS
(p < 0.001) but not in POMS. Females
with ROMS retire significantly (p < 0.001)
earlier (42.8 versus 44.2 years) and to a
greater extent than males (28 versus 24%).
Disease progression was similar for women and men. Conclusion: Our analysis shows that clinical and demographic data differ more
between disease courses than between men and women. For pain,
depression and cognitive impairment the female sex is the
decisive factor. Whether these factors are responsible for the
earlier retirement of females with ROMS is not clear.
Appropriate measures for optimization of symptomatic treatment
as well as to promote employment should be taken.
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Affiliation(s)
- Paulus Stefan Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Gehlsheimer Straße 20, Rostock, 18147, Germany
| | - David Ellenberger
- German MS-Register by the German MS Society, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | - Kerstin Hellwig
- Department of Neurology, Katholisches Klinikum Bochum, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Judith Haas
- Centre for Multiple Sclerosis, Jewish Hospital Berlin, Berlin, Germany
| | - Dieter Pöhlau
- Department of Neurology, German Red Cross-Kamillus-Clinic, Asbach, Germany
| | - Alexander Stahmann
- German MS-Register by the German MS Society, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | - Uwe Klaus Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
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32
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Zhang Y, Taylor BV, Simpson S, Blizzard L, Campbell JA, Palmer AJ, van der Mei I. Feelings of depression, pain and walking difficulties have the largest impact on the quality of life of people with multiple sclerosis, irrespective of clinical phenotype. Mult Scler 2020; 27:1262-1275. [DOI: 10.1177/1352458520958369] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: The symptoms that have the largest impact on health-related quality of life (HRQoL) in people with multiple sclerosis (MS) may vary by MS phenotype (relapsing-remitting MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS)). Knowing these symptoms assists in symptom management. Objective: To examine the associations between 13 common MS symptoms and HRQoL in the total sample and stratified by MS phenotype. Method: The study included 1985 participants. HRQoL was measured with two multi-attribute utility instruments: assessment of quality of life with eight dimensions (AQoL-8D) and European quality of life with five dimensions and five levels for each dimension (EQ-5D-5L). Multivariable linear regression was used to identify the symptoms that had the largest impact on the HRQoLs. Results: Feelings of depression, pain, fatigue, and feelings of anxiety were most strongly associated with AQoL-8D and EQ-5D-5L. Walking difficulties additionally contributed to reduced EQ-5D-5L. The strongest single predictors in the multivariable analyses were feelings of depression or pain for AQoL-8D and walking difficulties for EQ-5D-5L, irrespective of MS phenotype. Conclusion: The strongest single predictors for the AQoL-8D and EQ-5D-5L were feelings of depression, pain and walking difficulties, irrespective of MS phenotype. Reducing these symptoms may have the largest impact on improving HRQoL in all MS phenotypes of people with MS.
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Affiliation(s)
- Yan Zhang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Abstract
Pain is an important and frequent symptom in multiple sclerosis (MS), which leads to a low quality of life, increased disability level, and lack of employment and mental health. Recently, studies have shown increased interest in pain in MS and there is a growing evidence of its prevalence. However, the literature suffers from lack of experimental studies focusing on pain reduction. This topical review summarizes the current knowledge about pain in MS with its definitions, assessments, treatments and rehabilitation within a holistic perspective.
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Affiliation(s)
- Cigdem Yilmazer
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium
| | - Ilse Lamers
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium/Rehabilitation and MS Center, Pelt, Belgium /University MS Center, UHasselt, Diepenbeek, Belgium
| | - Claudio Solaro
- Department of Rehabilitation, Associazione Silenziosi Operai della Croce, Onlus, Moncrivello, Italy
| | - Peter Feys
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium//University MS Center, UHasselt, Diepenbeek, Belgium
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34
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Agüera E, Caballero-Villarraso J, Feijóo M, Escribano BM, Bahamonde MC, Conde C, Galván A, Túnez I. Impact of Repetitive Transcranial Magnetic Stimulation on Neurocognition and Oxidative Stress in Relapsing-Remitting Multiple Sclerosis: A Case Report. Front Neurol 2020; 11:817. [PMID: 32903741 PMCID: PMC7438891 DOI: 10.3389/fneur.2020.00817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 06/29/2020] [Indexed: 01/15/2023] Open
Abstract
Multiple sclerosis (MS) is a neurodegenerative condition whose manifestation and clinical evolution can present themselves in very different ways. Analogously, its treatment has to be personalized and the patient's response may be idiosyncratic. At this moment there is no cure for it, in addition to its clinical course sometimes being torpid, with a poor response to any treatment. However, Transcranial Magnetic Stimulation (TMS) has demonstrated its usefulness as a non-invasive therapeutic tool for the treatment of some psychiatric and neurodegenerative diseases. Some studies show that the application of rTMS implies improvement in patients with MS at various levels, but the effects at the psychometric level and the redox profile in blood have never been studied before, despite the fact that both aspects have been related to the severity of MS and its evolution. Here we present the case of a woman diagnosed with relapsing-remitting multiple sclerosis (RRMS) at the age of 33, with a rapid progression of her illness and a poor response to different treatments previously prescribed for 9 years. In view of the patient's clinical course, a compassionate treatment with rTMS for 1 year was proposed. Starting from the fourth month of treatment, when reviewing the status of her disease, the patient denoted a clear improvement at different levels. There followed out psychometric evaluations and blood analyses, that showed both an improvement in her neuropsychological functions and a reduction in oxidative stress in plasma, in correspondence with therTMS treatment.
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Affiliation(s)
- Eduardo Agüera
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Neurología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Javier Caballero-Villarraso
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departmento de Bioquímica y Biología Molecular, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain.,Unidad de Gestión Clínica de Análisis Clínicos, Hospital Universitario Reina Sofía, Córdoba, Spain.,Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Córdoba, Spain
| | - Montserrat Feijóo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departmento de Bioquímica y Biología Molecular, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain
| | - Begoña M Escribano
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Córdoba, Spain
| | - María C Bahamonde
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Neurología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Cristina Conde
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Alberto Galván
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departmento de Bioquímica y Biología Molecular, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain
| | - Isaac Túnez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departmento de Bioquímica y Biología Molecular, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain
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35
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Valburg C, Sonti A, Stern JN, Najjar S, Harel A. Dietary factors in experimental autoimmune encephalomyelitis and multiple sclerosis: A comprehensive review. Mult Scler 2020; 27:494-502. [PMID: 32406797 DOI: 10.1177/1352458520923955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dietary intervention in multiple sclerosis carries potential therapeutic implications. While studies utilizing animal models of multiple sclerosis (MS) have demonstrated intriguing findings, well-designed clinical trials are few in number. OBJECTIVE The objective of this study is to review the animal model and clinical literature regarding dietary factors in experimental autoimmune encephalitis (EAE) and MS. METHODS This manuscript provides a comprehensive review of current animal model and clinical knowledge related to dietary factors in MS. RESULTS While there is currently little data for any specific diet in MS, there is growing evidence that certain dietary factors may influence the disease. CONCLUSIONS Definitive information regarding dietary factors as a modifiable risk factor in MS will require larger randomized clinical trials.
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Affiliation(s)
- Claire Valburg
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Anup Sonti
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Joel Nh Stern
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA/Institute of Molecular Medicine, The Feinstein Institute for Medical Research, Manhasset, NY, USA/Department of Neurology, Lenox Hill Hospital, New York, NY, USA
| | - Souhel Najjar
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA/Institute of Molecular Medicine, The Feinstein Institute for Medical Research, Manhasset, NY, USA/Department of Neurology, Lenox Hill Hospital, New York, NY, USA
| | - Asaff Harel
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA/Institute of Molecular Medicine, The Feinstein Institute for Medical Research, Manhasset, NY, USA/Department of Neurology, Lenox Hill Hospital, New York, NY, USA
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36
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Masuda H, Mori M, Uzawa A, Uchida T, Ohtani R, Kuwabara S. Difference in fatigue and pain between neuromyelitis optica spectrum disorder and multiple sclerosis. PLoS One 2020; 15:e0224419. [PMID: 32251416 PMCID: PMC7135064 DOI: 10.1371/journal.pone.0224419] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 10/14/2019] [Indexed: 01/17/2023] Open
Abstract
Objective To investigate the difference of fatigue and pain in patients with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). Methods Data from the Modified Fatigue Impact Scale (MFIS) and Pain Effects Scale (PES) were compared between 51 NMOSD and 85 MS patients. Each score was compared in each disease group with or without clinical abnormalities. Since almost no MS patients are without brain magnetic resonance imaging abnormalities, volumetry analysis by the Lesion Segmentation Tool and statistical parametric mapping 12 were added to obtain total lesion volume and intracranial volume in MS patients, and the correlations between total lesion volume/intracranial volume and each score were investigated. Results Compared to the MS group, the NMOSD group showed a higher PES score (median, 15.0 vs. 7.0, P = 0.045), no difference in MFIS, and an increased percentage of patients with extended spinal cord lesions (58.8% vs. 8.2%, P < 0.001). Moreover, NMOSD and MS patients with extended spinal cord lesions tended to demonstrate higher PES scores than those without. A positive correlation between MFIS and PES were found in patients with NMOSD and MS. On the other hand, MS patients showed a higher percentage of brain abnormalities (80.4% vs. 97.6%, P = 0.001) and a positive correlation between total lesion volume/intracranial volume and MFIS (Spearman’s ρ = 0.50, P = 0.033). Conclusions The origin of fatigue may be associated with spinal cord lesions causing pain in NMOSD patients, but with brain lesions in MS patients.
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Affiliation(s)
- Hiroki Masuda
- Department of Neurology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Masahiro Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
- * E-mail:
| | - Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Tomohiko Uchida
- Department of Neurology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Ryohei Ohtani
- Department of Neurology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
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37
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Kołtuniuk A, Przestrzelska M, Karnas A, Rosińczuk J. The Association Between Sexual Disorders and the Quality of Life of Woman Patients With Multiple Sclerosis: Findings of a Prospective, Observational, and Cross-Sectional Survey. Sex Med 2020; 8:297-306. [PMID: 32238329 PMCID: PMC7261679 DOI: 10.1016/j.esxm.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/31/2020] [Accepted: 02/20/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction Multiple sclerosis (MS) is a progressive, chronic inflammatory demyelinating disease of the central nervous system, whose symptoms include sexual disorders. Sexual dysfunctions can influence on quality of life (QOL) of patients with MS. Aim To evaluate the occurrence of sexual disorders among women with MS and correlations between QOL, prevalence of sexual disorders, and level of sexual satisfaction. Methods Polish women (n = 101) aged 22–66 years with diagnosed MS were included in the study. Main Outcome Measures The Female Sexual Function Index, the Sexual Satisfaction Questionnaire, the Satisfaction with Life Scale, and the Multiple Sclerosis International Quality of Life Questionnaire were used. In addition, an Authors-Designed Questionnaire was used to collect sociodemographic data. Results More than half of the patients surveyed were totally or somewhat unsatisfied with their sex life, and 44.55% of the patients were diagnosed with significant sexual disorders. It was shown that patients with diagnosed sexual disorders and a low level of sexual satisfaction rated their QOL the lowest among all the surveyed patients. Conclusion Our findings indicate that sexual disorders and the level of sexual satisfaction correlate significantly with QOL in patients with MS. Sexual dysfunctions are a significant problem in women with MS; thus, they should be considered with comprehensive care. Kołtuniuk A, Przestrzelska M, Karnas A, et al. The Association Between Sexual Disorders and the Quality of Life of Woman Patients With Multiple Sclerosis: Findings of a Prospective, Observational, and Cross-Sectional Survey. Sex Med 2020;8:297–306.
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Affiliation(s)
- Aleksandra Kołtuniuk
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland.
| | - Monika Przestrzelska
- Department of Gynecology and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra Karnas
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Rosińczuk
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
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38
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Amtmann D, Bamer AM, Askew R, Jensen MP. Cross-lagged longitudinal analysis of pain intensity and sleep disturbance. Disabil Health J 2020; 13:100908. [PMID: 32081590 DOI: 10.1016/j.dhjo.2020.100908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 01/23/2020] [Accepted: 02/08/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is substantial evidence that pain intensity and sleep are related, with findings generally suggesting more support for the influence of sleep on pain intensity than vice versa. However, the strength and direction of the relationship has been found to vary among different populations, with few studies in individuals with chronic physical disabilities. OBJECTIVE Examine the directionality of the sleep and pain relationship in individuals with chronic physical disabilities. METHODS Cross-lagged effects models were generated using data from a longitudinal observational survey study of individuals (N = 1660) with multiple sclerosis (MS), muscular dystrophy (MD), post-polio syndrome (PPS), and spinal cord injury (SCI). Models evaluated the correlational effects of sleep disturbance and pain intensity, as well as the cross-lagged effects of sleep disturbance to pain intensity and vice versa. RESULTS The effects of pain on sleep were stronger than sleep on pain, although the magnitude of the effects were both relatively weak. Analyses within individual samples were consistent with the overall sample results for MS, MD, and PPS. In the SCI sample the magnitude and direction of the cross-lagged model paths were more variable than in the other samples. CONCLUSIONS The relationship between pain intensity and sleep disturbance appears bi-directional, but the effects are small in a sample of individuals with long-term disabilities. The temporal effects of pain on sleep disturbance appear stronger than the effects of sleep disturbance on pain intensity. Future research is needed to better understand this relationship in the context of pain and/or sleep disturbance treatments.
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Affiliation(s)
- Dagmar Amtmann
- University of Washington, Rehabilitation Medicine, Box 354237, 4907 25th Ave NE, Seattle, WA, 98105, USA.
| | - Alyssa M Bamer
- University of Washington, Rehabilitation Medicine, Box 354237, 4907 25th Ave NE, Seattle, WA, 98105, USA.
| | - Robert Askew
- University of Washington, Rehabilitation Medicine, Box 354237, 4907 25th Ave NE, Seattle, WA, 98105, USA.
| | - Mark P Jensen
- University of Washington, Rehabilitation Medicine, Box 354237, 4907 25th Ave NE, Seattle, WA, 98105, USA.
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39
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Crouse DL, Foroughi I, Gupta N. Neighbourhood environments and the risk of hospital admission for cardiometabolic and mental health comorbidities in multiple sclerosis: A population cohort analysis using linked administrative data. Mult Scler 2019; 27:315-319. [PMID: 31858881 DOI: 10.1177/1352458519895985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study exploits administrative data for neuroepidemiological research and examines associations between neighbourhood environments and risk of hospitalization among multiple sclerosis (MS) patients in New Brunswick, Canada. We created a provincial database of MS patients by linking administrative health records with geographic-based characteristics of local communities. Using Cox models, we found the risk of admission for cardiometabolic complications was lower among residents of ethnically homogeneous neighbourhoods (hazards ratio [HR]: 0.75 [95% confidence interval (CI): 0.60-0.95]); that for mental health disorders was higher in socioeconomically deprived (HR: 1.80 [95% CI: 1.06-3.05]) and residentially unstable (HR: 1.61 [95% CI: 1.05-2.46]) neighbourhoods. Results suggest that selected neighbourhood environments may be associated with differential hospital burden among MS patients.
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Affiliation(s)
- Dan Lawson Crouse
- Department of Sociology, University of New Brunswick, Fredericton, NB, Canada/NB Institute for Research, Data and Training, University of New Brunswick, Fredericton, NB, Canada
| | - Ismael Foroughi
- Department of Sociology, University of New Brunswick, Fredericton, NB, Canada
| | - Neeru Gupta
- Department of Sociology, University of New Brunswick, Fredericton, NB, Canada
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40
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Grubić Kezele T, Babić M, Kauzlarić-Živković T, Gulić T. Combined upper limb and breathing exercise programme for pain management in ambulatory and non-ambulatory multiple sclerosis individuals: part II analyses from feasibility study. Neurol Sci 2019; 41:65-74. [PMID: 31422507 DOI: 10.1007/s10072-019-04046-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/13/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE The present small semi-controlled feasibility study investigated a possible efficacy of a combined upper limb and breathing exercise programme in managing pain in ambulatory and non-ambulatory patients with EDSS from 0.0-8.0. METHOD People with MS (N = 19) were enrolled in this single-blind randomized controlled study and divided into 2 groups: exercise group (5 ambulatory, 5 non-ambulatory; Expanded Disability Status Scale (EDSS), 1.0-8.0) and related control group that performed no exercise (4 ambulatory, 5 non-ambulatory; EDSS, 1.0-7.5). The exercise group performed combined upper limb and breathing exercises in a group led by a physiotherapist (2 days/week, 60 min/session) accompanied by independent home exercises (3 days/week, ≥ 20 min/session). Participants underwent measures of pain level (visual analogue scale) for physical pain, functional independence of daily activities (Barthel index) and handgrip strength (HGS) for dominant (D) and non-dominant (ND) hand evaluated by a dynamometer before and after the 4-week period by the blinded assessor. RESULTS The VAS for pain showed statistically significant group-by-time interaction only in non-ambulatory (p = .049) individuals, but with large intervention effects on both subgroups (ambulatory, p = .159; non-ambulatory, d = 0.97). Functional independence in daily activities (Barthel index) showed statistically non-significant group-by-time interaction in ambulatory (p = .195, d = 0.89) and non-ambulatory (p = .102, d = 1.64) individuals, but despite the absence of statistical significance, there were large intervention effects. Handgrip strength was significantly improved for both hands in ambulatory (D, p = .012; d = 2.07; ND, p = .025, d = 1.77) and only non-dominant hand in non-ambulatory individuals (D, p = .288, d = 0.83; ND, p = .012, d = 2.21). CONCLUSION This small pilot study provides preliminary proof-of-concept data supporting low-intensity upper limb and breathing exercise programme for potential reduction of pain and improvement of functional independence in both ambulatory and non-ambulatory individuals with MS in a larger sample and that strengthening the upper limbs might be an additional pain relief mechanism. TRIAL REGISTRATION NTC03222596.
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Affiliation(s)
- Tanja Grubić Kezele
- Department of Physiology and Immunology, University of Rijeka, Faculty of Medicine, B. Branchetta 20, 51000, Rijeka, Croatia.
| | - Matea Babić
- Department of Physiotherapy, University of Rijeka, Faculty of Health Studies, Rijeka, Croatia
| | | | - Tamara Gulić
- Department of Physiology and Immunology, University of Rijeka, Faculty of Medicine, B. Branchetta 20, 51000, Rijeka, Croatia
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41
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Urits I, Adamian L, Fiocchi J, Hoyt D, Ernst C, Kaye AD, Viswanath O. Advances in the Understanding and Management of Chronic Pain in Multiple Sclerosis: a Comprehensive Review. Curr Pain Headache Rep 2019; 23:59. [PMID: 31342191 DOI: 10.1007/s11916-019-0800-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system that can lead to severe physical, cognitive, and neurological deficits that often manifest in young adults. Central neuropathic pain is a common presenting symptom, often prompting patients to seek treatment with opioids, NSAIDS, antiepileptics, and antidepressants despite minimal effectiveness and alarming side-effect profiles. Additionally, spasticity occurs in more than 80% of MS patients and is an important consideration for further study in treatment. RECENT FINDINGS Related to inconsistencies in pain presentation and clinical reporting, current studies continue to investigate clinical patient presentation to define chronic pain characteristics to optimize treatment plans. Although often neuropathic in origin, the complex nature of such pain necessitates a multimodal approach for adequate treatment. While psychiatric comorbidities typically remain unchanged in their severity over time, physical conditions may lead to worsening chronic pain long-term, often due to decreased quality of life. The prevalence of neuropathic pain is ~ 86% in patients with multiple sclerosis and most commonly presents as extremity pain, trigeminal neuralgia, back pain, or headaches. As MS symptoms are frequently unremitting and poorly responsive to conventional medical management, recent attention has been given to novel interventions for management of pain. Among these, medicinal cannabis therapy, targeted physical therapy, and neuromodulation offer promising results. In this review, we provide a comprehensive update of the current perspective of MS pathophysiology, symptomatology, and treatment.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Leena Adamian
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Jacob Fiocchi
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Dylan Hoyt
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Carly Ernst
- A T Still University, Kirksville College Of Osteopathic Medicine, Kirksville, MO, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
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42
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Marck CH, das Nair R, Grech LB, Borland R, Constantinescu CS. Modifiable risk factors for poor health outcomes in multiple sclerosis: The urgent need for research to maximise smoking cessation success. Mult Scler 2019; 26:266-271. [PMID: 31219393 PMCID: PMC7065446 DOI: 10.1177/1352458519858730] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tobacco smoking is a well-established risk factor for multiple sclerosis (MS) onset, progression and poor health outcomes in people with MS. Despite smoking being a modifiable risk factor, no research has been undertaken to understand how, or who is best placed, to assess or understand smoking behaviour in people with MS, or how healthcare professionals can best assist people with MS to quit. People with MS may have unique motivators to continue smoking, or unique barriers to smoking cessation, that are not addressed by existing cessation tools. Research is urgently needed in this area if the aim is to maximise health outcomes for all people with MS.
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Affiliation(s)
- Claudia H Marck
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Roshan das Nair
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK/Institute of Mental Health, Nottingham, UK
| | - Lisa B Grech
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia/Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia/Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Ron Borland
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia/Cancer Council Victoria, Melbourne, VIC, Australia/Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Exploring the feasibility of a mild and short 4-week combined upper limb and breathing exercise program as a possible home base program to decrease fatigue and improve quality of life in ambulatory and non-ambulatory multiple sclerosis individuals. Neurol Sci 2019; 40:733-743. [PMID: 30659416 DOI: 10.1007/s10072-019-3707-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/05/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the feasibility of a combined upper limb and breathing exercise for a home-based program and to explore its effect on primary fatigue and quality of life in ambulatory and non-ambulatory individuals with multiple sclerosis (MS) in a short time. METHOD Nineteen individuals with MS were assigned into semi-controlled pre-post feasibility study based on Expanded Disability Status Scale (EDSS) status and divided into two groups: exercise (five ambulatory, five non-ambulatory; EDSS 1.0-8.0) and related control with no exercise (four ambulatory, five non-ambulatory; EDSS 1.0-7.5). Exercise group performed combined upper limb and breathing exercise in a controlled group (2 days/week, 60 min/session) accompanied by independent home exercise (3 days/week, ≥ 20 min/session). Participants underwent measures of fatigue impact (Modified Fatigue Impact Scale (MFIS) and quality of life (RAND Medical outcomes study 36-item short-form health survey (SF-36)) before and after a 4-week period. RESULTS The MFIS (physical, psychosocial, total) showed statistically significant group-by-time interaction in ambulatory (p = 0.033, d = 1.60; p = 0.039, d = 1.59; p = 0.033, d = 1.62) and non-ambulatory individuals (p = 0.009, d = 2.42; p = 0.018, d = 1.96; p = 0.0008, d = 3.92). Physical functioning (SF-36) showed statistically significant group-by-time interaction in ambulatory (p = 0.014, d = 2.14) but no significance in non-ambulatory (p = 0.368, d = 0.68) individuals. Despite the absent statistical significance, there were large intervention effects on MFIS cognitive scores for ambulatory (d = 1.28) and non-ambulatory (d = 1.47), and on other SF-36 scores for ambulatory (general health: d = 1.76 and pain: d = 1.02) and non-ambulatory (physical limitation: d = 1.03 and emotional well-being: d = 0.94) individuals. CONCLUSION Our 4-week program reduced some aspects of fatigue and improved some aspects of quality of life in a small group of ambulatory and non-ambulatory individuals with MS. Good feasibility and significant positive changes from baseline warrant further exploratory work. TRIAL REGISTRATION Name of the registry: The Impact of Exercise Training on Living Quality in Multiple Sclerosis. Registration: The study was registered at www.clinicaltrial.gov on July 14, 2017. First participant enrollment: August 28, 2017. URL: 602-01/17-01-147; Trial registration ID: NTC03222596.
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Pilutti LA, Motl RW. Body composition and disability in people with multiple sclerosis: A dual-energy x-ray absorptiometry study. Mult Scler Relat Disord 2019; 29:41-47. [PMID: 30658263 DOI: 10.1016/j.msard.2019.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Body composition refers to the relative distribution of different tissue types within the body, including fat, lean, and bone tissues. There is evidence for associations between body composition and the development of multiple sclerosis (MS). The relationship between body composition and disease progression and disability accumulation, however, is unclear. OBJECTIVES To examine: a) differences in overall and regional body composition by disability status in persons with multiple sclerosis (MS); and b) the relationship between body composition and other outcomes reflecting impairments and limitations due to MS. METHODS Cross-sectional investigation of 47 ambulatory persons with relapsing remitting MS who were grouped by Expanded Disability Status Scale (EDSS) scores as having mild (1.0-4.0; n = 26) or moderate (4.5-6.5; n = 21) disability. Main outcome measures were whole-body and regional soft tissue composition (%body fat (BF), fat mass (FM), and fat-free soft tissue mass (FFM)), bone mineral content (BMC), and bone mineral density (BMD) determined from dual-energy X-ray absorptiometry (DXA). Other outcomes included physical fitness, mobility, cognitive processing speed, symptoms, and health-related quality of life (HRQOL). RESULTS Whole-body and regional %BF and FM were significantly higher, and whole-body and appendicular BMC and BMD were significantly lower in participants with moderate disability than those with mild disability (all p < .05). There were no significant differences in whole-body or regional FFM by disability status. In the overall sample, body fat correlated significantly with cardiorespiratory fitness (prs = -.52 to -.56), pain symptoms (prs = .32), and psychological HRQOL (prs = .34). FFM (prs = .38-.48) and BMC (prs = .53-.69) correlated primarily with measures of muscular strength. CONCLUSIONS Persons with MS who have greater disability present with higher body fat and lower bone tissue content and density than those with mild disability. These findings highlight the need for strategies that address potential changes in body composition with disability accumulation.
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Affiliation(s)
- Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, 200 Lees Avenue, Ottawa, ON K1N 6N5, Canada.
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, 1705 University Blvd., Birmingham, AL 35233-1212, USA
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Carta MG, Paribello P, Anastasia A, De Berardis D, Nardi AE, Fornaro M. Pharmacological management of depression in patients with multiple sclerosis. Expert Opin Pharmacother 2018; 19:1533-1540. [PMID: 30207800 DOI: 10.1080/14656566.2018.1516207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The pharmacotherapeutic management of depression in patients with multiple sclerosis (MS) is a matter of debate that cannot be decided from the evidence available in the current literature. Therefore, its management essentially relies on the clinical experience of the prescribing clinician rather than on evidence-based approaches. AREAS COVERED This review provides a clinically oriented critical perspective on the connection between MS and major depressive disorder (MDD) or depression associated with bipolar disorder (BD), focusing on its optimal pharmacotherapy. Both clinical and pharmacological considerations are accounted in order to promote rational pharmacotherapy, both in terms of efficacy and tolerability. EXPERT OPINION Despite its clinical burden and relatively frequent occurrence, the interplay of MS and depression still requires further controlled trials to better clarify the appropriate pharmacotherapy across varying 'diseases categories' of MS itself, as well as discriminating between depressive symptoms that do not necessarily reach the threshold of either MDD or BD. Additional insight into new mood-tolerated neurological pharmacotherapy for MS is likewise warranted toward a more effective, immune- and patient-tailored pharmacotherapy, while promoting innovation in drug design, with the ultimate goal of enhancing the overall quality life of the affected individual, his/her caregivers, and to reduce the associated economic and social burden.
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Affiliation(s)
- Mauro Giovanni Carta
- a Department of Health Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Pasquale Paribello
- a Department of Health Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | | | | | - Antonio Egidio Nardi
- d Medical School - Institute of Psychiatry , Federal University of Rio de Janeiro National Academy of Medicine , Rio de Janeiro , Brazil
| | - Michele Fornaro
- e Neuroscience, Reproductive Science and Odontostolmatology , Federico II University of Naples , Naples , Italy
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