Activity restriction, pain and mood across the lifespan in adults with multiple sclerosis or spinal cord injury.

TitleActivity restriction, pain and mood across the lifespan in adults with multiple sclerosis or spinal cord injury.
Publication TypeJournal Article
AuthorsMolton IR, Jensen MP, Amtmann D, Johnson KL, Ehde DM, Kraft GH
JournalMultiple Sclerosis
Issue9 Suppl

Goals and objective: Chronic pain remains one of the most challenging medical symptoms faced by older patients. Although aging in itself is a risk factor for the development of chronic pain, it is also associated with greater prevalence of physical disabilities, including multiple sclerosis (MS) and spinal cord injury (SCI). These conditions are very commonly associated with a number of unique chronic pain problems, including neuropathic pain or paresthesias, chronic headache, and painful tonic spasms. The majority of patients with these disabilities report chronic painful sensations, and from 1/4 to 1/3 report the pain as severe. It has also been suggested that the impact of chronic pain on mood is mediated by restrictions in normal daily activities, and that this relationship may be less salient in older adults (for whom activity restriction is more normative). The present study sought to test this model among adults living with chronic pain secondary to either MS or SCI. Design: Cross-sectional survey. Participants: 1,331 adults (201 older, 807 middle aged, and 323 younger) reporting chronic pain secondary to either multiple sclerosis (MS; n¼ 821) or spinal cord injury (SCI; n ¼ 510). Participants were divided into three age groups (20-40, 40-60, 60+). Main Outcome Measures: Numeric rating scale to measure average pain intensity in the past week, the Brief Pain Inventory to measure pain interference, and the Center for Epidemiological Studies- Depression scale to measure depressive symptoms. Results: Multiple regression analyses indicated that after controlling for clinical and demographic variables, the relationship between pain intensity and depressed mood was mediated by pain related restriction for all age groups. However, the strength of the indirect effect varied by age, and was strongest among middle-aged adults and weakest in older adults (Sobel statistic: Younger ¼ 9.57; Middle-aged ¼ 12.35; Older ¼ 4.83; all p’s < .01). Conclusions: The results confirm previous findings that activity restriction largely accounts for the impact of pain on mood, and extends this finding to a sample of adults with disability-related pain. The results also suggest that all adults appear to find pain related activity restriction distressing, regardless of age. However, pain may have the largest impact in adults with the greatest levels of required activity, responsibility and other burdens (i.e., those in middleadulthood).

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