Pain in Women With Relapsing-remitting Multiple Sclerosis and in Healthy Women: A Comparative Study

Pamela Newland


J Neurosci Nurs. 2008;40(5):262-268. 

In This Article


Sample and Setting

In a convenience sample, 40 women with RRMS were recruited from an MS clinic in the Midwestern United States during their regularly scheduled appointments. Participants were older than 18 years of age, had been diagnosed with MS for longer than 6 months, and were able to speak and understand English. Exclusion criteria included the presence of another autoimmune-neurologic disease; chronic illness that may cause pain (e.g., diabetes mellitus, chronic renal failure, or osteo-arthritis); cancer (other than skin cancer [e.g., melanoma]); psychotic psychiatric disease; or a Paced Auditory Serial Addition Test (PASAT) score of fewer than two answers correct out of 60 possible answers.

The PASAT, a component of the MS Functional Composite (MSFC) testing (Rudick et al., 1997), was administered for cognitive screening. The score for the PASAT is the total number correct out of 60 possible answers. The participant was considered limited cognitively if she could not answer at least two items correctly on the 3-second PASAT test (Fischer, Jak, Kniker, Rudick, & Cutter, 2001). The concurrent validity and reliability of the PASAT is established for the MS population (Aupperle, Beatty, Shelton, & Gontkovsky, 2002; Hoogervorst et al., 2001). In addition, a convenience sample of 40 healthy women matched by age (±2 years) and living location (urban or rural) to the participants with MS were recruited by posting flyers in a Midwestern U.S. city and its surrounding metropolitan community.


Institutional review board approval was obtained prior to data collection. After potential participants were informed of the purpose of the study and had signed a written informed consent, they were asked to complete the demographic data/health history forms. The Brief Pain Inventory-Long Form (BPI-LF) and McGill Pain Questionnaire-Short Form (MPQ-SF) were read to the participant and completed by the researcher. Participants who reported having had pain over the last 7 days were asked to mark the location of their pain on a BPI-LF body diagram. The participants who reported present pain were asked to mark through the visual analogue scale (VAS) on the MPQ-SF.


This study examined the symptom of pain in two ways: (a) demographically and (b) by means of health history information. Descriptions of each instrument are given below.

Demographic and Health History Forms. These forms included information on demographics and health history, such as marital status, employment status, educational level, type and dose of pain medication, and other information.

Brief Pain Inventory-Long Form. The BPI-LF (Daut, Cleeland, & Flanery, 1983) was used to obtain data about pain presence, average intensity, location, and interference with daily life over the last 7 days. Concurrent validity of the BPI-LF had been established in the MS literature (Ehde et al., 2003). The BPI-LF items categorize participants' pain as "yes" for pain and "no" for no pain. The BPI-LF consists of numeric rating-scale items ranging from 0 (no pain) to 10 (pain as bad as you can imagine) to measure the intensity of pain over the last 7 days (pain-intensity item includes choices such as worst, least, average, right now) and how pain interferes with daily life (e.g., general activity, mood, and walking). Seven items on a scale from 0 (does not interfere) to 10 (completely interferes) describe pain interference with general activities.

In addition, a diagram with a rear-and-front view of a human figure allowed the participant to mark areas for pain location. Each area marked with the letter X was counted using the scoring template that accompanies the BPI-LF. The body diagram was divided into 49 different areas, with certain areas combined to report results. All participants were asked to mark on the body diagram where their pain was the worst. Each assessment using the body diagram was assigned a grouped category (e.g., head/neck, chest/abdomen, arms, legs, back) based on the sites the participants had marked.

McGill Pain Questionnaire-Short Form. The MPQ-SF (Melzack, 1987) was used to measure present pain intensity, present pain descriptors, and present pattern of pain. The MPQ-SF contains 11 items for assessing sensory dimensions of pain and 4 items for affective dimensions that describe present pain. Scoring for the intensity of each descriptor is through the use of a Likert-type scale with categorizations of 0 = none; 1 = mild; 2 = moderate; and 3 = severe for each of the 15 descriptor words. A VAS and present-pain intensity (PPI) from the MPQ-SF also were included for assessing present-pain intensity. The VAS on the MPQ-SF is scored on a continuous, 0-to-10–cm line with the anchors no pain to worst possible pain to measure present pain intensity. The PPI has six choices of word-number combinations, from 0/no pain to 5/excruciating pain. To determine the present pattern of pain, the participant chose one word-number group from the MPQ-SF. This item categorizes the participants' present pattern of pain into three groups of words: (a) brief, momentary, transient; (b) rhythmic, periodic, intermittent; and (c) continuous, steady, constant. Concurrent validity between the long and short forms of the MPQ has been established with MS-study participants (Svendsen et al., 2005; Svendsen et al., 2003).

Data Analysis

Descriptive statistics (e.g., proportion, range, mean, standard deviation) were used to analyze demographic/medical history data for the two groups. The chi-square test for categorical data was used to compare presence of pain, present pattern of pain, present pain descriptors, and pain location over the last 7 days. Present pattern of pain and present pain descriptors were measured using frequencies of the words patients chose from the MPQ-SF. Frequencies were used for pain location over the last 7 days by calculating the areas patients indicated on the body diagram of the BPI-LF. Nonparametric tests (e.g., the Wilcoxon rank sum test) were conducted to examine differences in present pain intensity (VAS and PPI of the MPQ-SF), average pain intensity, and pain interference over the last 7 days (BPI-LF) between women with RRMS and healthy women. The Fisher exact test was performed to determine differences in present-pain descriptor intensity. Data were analyzed using Statistical Analysis System® (SAS®) version 9.1.


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