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

Pamela Newland

Disclosures

J Neurosci Nurs. 2008;40(5):262-268. 

In This Article

Discussion

These data suggest that pain is particularly problematic for women with RRMS. This result may be related to the pathophysiology of MS (Howarth, 2002; Kerns et al., 2002; Maloni, 2000; Rae-Grant et al., 1999; Svendsen et al., 2005). Specifically, the presence of a demyelinated lesion on the spinal cord directly injures nerves of the brain and spinal cord in persons with MS (Ehde et al., 2003; Moulin, 1998). In addition, pain in women with RRMS may be due to the inflammatory process that occurs with relapses. Regardless of the cause, it is critical that pain be identified and effectively managed in women with RRMS.

Pain intensity was found to be higher in women with RRMS compared with healthy women (Fig 1). Because lesions in RRMS have an affinity for the spinothalamic tract and somatosensory pathways of the brain and spinal cord, women with RRMS may have alterations in their sensory-affective perception of pain intensity when they have a relapse of MS (Moulin, 1998). Notably, even though most women with RRMS were taking daily analgesics for pain, their pain nevertheless was more intense than that of healthy women. Therefore, the use of OTC analgesics may not be effective for relieving pain in women with RRMS. However, it was not possible to reach a definitive conclusion from these data because self-management of pain (i.e., if medication was taken, what type was taken, and when it was taken) before the clinic appointment was not controlled in this study. Overall, these data indicate that women with RRMS represent a unique population that experiences pain intensity differently than healthy women.

It is not clear why pain locations were different in women with RRMS compared with healthy women. However, the pain locations reported in this study were similar to those reported in previous studies (Archibald et al., 1994; Beiske et al., 2004; Solaro et al., 2004; Svendsen et al., 2003). It is possible that back and leg pain in MS may be caused by inadequate blood flow to nerve cells in the posterior column of the spinal cord (Moulin, 1998). Another explanation for back and leg pain may be the buckling of dorsal roots of the posterior column caused by sclerotic plaques (Archibald et al.; Moulin). Because women with RRMS report pain in locations that are different from those of healthy women, it is essential that nurses assess pain location and provide adequate pain management in people with MS.

Interestingly, women with RRMS more frequently reported that pain interfered with their daily lives than did healthy women (Fig 2). High pain interference may be explained by the higher pain intensity and the location of pain in the back and legs in women with RRMS. Pain in the back and legs may adversely influence physical activities such as walking and working (Stuifbergen, Becker, Blozis, Timmerman, & Kullberg, 2003). As such, pain interference constitutes another important dimension for further evaluation when monitoring the effectiveness of pain management in women with RRMS.

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