Overview: In the first year after diagnosis of multiple sclerosis, 60% of patients experience fatigue, 50% pain, 47% have symptoms of depression, and 39% report increased anxiety. Researchers say urgent, non-pharmaceutical therapies should be provided to newly diagnosed MS patients to help reduce both pain and psychological symptoms.
Source: University of Washington
Two recently published studies by UW Medicine researchers indicate that clinicians should provide non-pharmaceutical help for pain, fatigue, depression, or anxiety at the time of diagnosis for patients with multiple sclerosis, rather than waiting.
The first study, published in the April 2022 issue of the Multiple Sclerosis Diary, noted that clinically significant levels of pain, fatigue, and depression, as well as anxiety, were commonly seen in newly diagnosed patients. The findings also indicated that rapid screening was necessary to maintain and optimize quality of life.
“The conclusion was that we had these symptoms, pain, fatigue, depression and anxiety quite prevalent” at the time of diagnosis, said Kevin Alschuler, principal investigator of this National MS Society-funded study. Alschuler heads the psychology department at UW Medicine’s Multiple Sclerosis Center.
The study found that 60% of patients suffered from fatigue; 50% experienced pain and 47% experienced depression, with 39% experiencing anxiety within the first year of diagnosis.
“We want to address this immediately, rather than five or ten years later,” he said.
According to the National Multiple Sclerosis Society, more than 1 million people live with MS in the United States. A majority live in cooler climates, such as the Northwest. The disease, for which there is no known cure or exact cause, works by something that triggers the body’s immune system to attack the brain and spinal cord.
The resulting damage to the myelin — the protective layer around nerve fibers — disrupts signals to and from the brain. The result is numbness, memory problems, pain, fatigue or even paralysis.
This study, as well as an accompanying study published in the May print edition of the Journal of Neurology, followed the same cohort of patients — largely white and female — for the first year after their diagnosis. In total, the studies followed 230 patients.
The patients were recruited from the UW Medicine Multiple Sclerosis Center and the MS Center of the Swedish Neuroscience Institute between 2014 and 2018.
The second study looked at patients’ quality of life immediately after, two months, three months, six months, nine months, and then a year after diagnosis. The results of the study showed that quality of life was largely stable year-round, on average, a finding that surprised researchers.
“Newly diagnosed patients have to deal with the emotional impact of the diagnosis, as well as numerous testing and treatment decisions,” noted Alschuler, who was the study’s lead author.
“The results showed that if they came in and did well with the diagnosis, they tended to stay that way for the entire first year,” Alschuler said. “When they were having a hard time, they tended to stay that way.”
Alschuler and his colleague Dawn Ehde are both interested in early non-pharmaceutical interventions for common symptoms experienced by MS patients. Ehde is a clinical psychologist and holds the Nancy and Buster Alvord endowed professorship in MS research in the Department of Rehabilitation Medicine at the UW School of Medicine.
Many times, patients had dealt with the symptoms years before a formal diagnosis, both noted.
“Through self-management of symptoms, including cognitive behavioral therapy, we are helping patients better cope with coping skills, especially in the areas of fatigue and pain,” said Ehde, co-author of the quality of life study published this month. .
With Alschuler, she has published studies demonstrating the effectiveness of such interventions in people who have had MS for years. Ehde was also one of the lead authors of the April study. who looked at the trajectory of symptoms one year after an MS diagnosis.
“We teach them how to use strategies such as relaxation or mindfulness meditation techniques, and how to adapt themselves to reduce fatigue and better manage stress,” she said. “Patients who learn these skills often find that not only do their pain and fatigue decrease, but they are able to do more of what is important to them despite their MS.”
The next step for the team is to explore options for early interventions to help newly diagnosed patients. Following on from this, Alschuler has teamed up with colleague Ivan Molton, another clinical psychologist, to develop an intervention to help newly diagnosed patients cope with the uncertainty that is central to living with MS.
Their 2019 pilot study looked at the impact of promoting uncertainty tolerance in improving quality of life and reducing anxiety. They followed this up with a larger clinical trial that recently completed data collection, Alschuler said. The results of that study are expected later this year.
About this research news on multiple sclerosis
Author: press office
Source: University of Washington
Contact: Press Office – University of Washington
Image: The image is in the public domain
Original research: Closed access.
†Prevalence, co-occurrence, and trajectories of pain, fatigue, depression, and anxiety in the year after multiple sclerosis diagnosisby Thomas R Valentine et al. Multiple Sclerosis Diary
Closed access.
†Quality of life in individuals newly diagnosed with multiple sclerosis or clinically isolated syndromeby Kevin N. Alschuler et al. Journal of Neurology
Abstract
Prevalence, co-occurrence, and trajectories of pain, fatigue, depression, and anxiety in the year after multiple sclerosis diagnosis
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Background:
Pain, fatigue, depression and anxiety are common in multiple sclerosis, but little is known about the presence, co-existence, and course of these symptoms in the year after multiple sclerosis (MS) diagnosis.
Objectives:
To determine during the year after diagnosis: (1) pain, fatigue, depression and anxiety; (2) rates of co-occurrence of symptoms; and (3) stability/change in symptom severity.
Methods:
Newly diagnosed adults with MS/clinically isolated syndrome (N = 230) completed self-report measures of pain, fatigue, depression, and anxiety 1, 2, 3, 6, 9, and 12 months after MS diagnosis. Clinical significance was defined based on standardized cutoffs. Descriptive statistics and Sankey diagrams characterized speeds and trajectories.
Results:
Participants endorsed clinically significant symptoms at some point in the year after diagnosis with rates of 50.9% for pain, 62.6% for fatigue, 47.4% for depression, and 38.7% for anxiety. A majority of patients had concomitant symptoms: 21.3% in two, 19.1% in three and 17.4% in four. The proportions of patients with clinically significant symptoms were generally stable over time; however, the rates of symptom development/recovery showed fluctuations at the individual level.
conclusions:
Pain, fatigue, depression, and anxiety are common in newly diagnosed MS. Rapid screening and evidence-based interventions are needed to optimize quality of life.
Abstract
Quality of life in individuals newly diagnosed with multiple sclerosis or clinically isolated syndrome
Background
Little is known about quality of life (QOL) at the time of diagnosis of multiple sclerosis (MS) or clinically isolated syndrome (CIS) and how it evolves in the critical adjustment period immediately after a new diagnosis.
Objectives
To (1) describe the QOL trajectory in the first year after MS/CIS diagnosis and (2) examine associations of demographic and biopsychosocial factors with QOL at baseline and as it develops in the first year after MS/CIS diagnosis. to research.
Methods:
Participants were: N= 250 newly diagnosed individuals with MS or CIS. Participants completed self-report assessments of QOL, demographics, and biopsychosocial factors at 1, 2, 3, 6, 9, and 12 months after diagnosis using validated measures.
Results
1 month after diagnosis, QOL m= 75.2/100 with subsequent ratings revealing consistent ratings on average. Modeling revealed a small number of variables that were predictive of HRoL at baseline and/or change in HRoL over time.
Conclusion
Quality of life in the first year after MS/CIS diagnosis was on average high and stable. A subset of modifiable factors across the biopsychosocial spectrum were associated with baseline level of QOL and change in QOL over time. The stability in QOL suggests that patients can be assessed early after diagnosis for important variables that are predictive of both current and future QOL.
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