Enhancements in despair associated enhancements in fatigue and ache in MS

Early reduction in depressive symptoms can lead to better improvement in dysfunction due to fatigue and pain in patients with multiple sclerosis (MS), according to patient results published in the Annals of Behavioral Medicine.

Depression, fatigue, and pain often coexist in MS patients, suggesting a possible association between these symptoms. The study’s researchers wanted to find out whether early improvements in depression, fatigue, or pain disorders in patients with MS were related to improvements in the other 2.

This study was a secondary analysis ( Identifier: NCT00944190) of a randomized controlled trial of 154 community adults with MS and chronic pain, chronic fatigue, and / or moderate depressive symptoms (mean age 52.59 years). These participants were randomly assigned to either a self-management intervention based on cognitive behavioral therapy (n = 69) or an educational intervention (n = 85) for 8 weeks.

Both interventions were combined in this secondary analysis. Results included depressive symptoms measured with the PHQ-9, effects of fatigue measured with the Modified Fatigue Impact Scale, and pain disorders measured with the Brief Pain Inventory. The study researchers used a pathway analysis that examined associations between the improvement before and during the intervention for one symptom and the improvement before and after the intervention for the other two symptoms.

There was a statistically significant association between the reduction in severity of depressive symptoms before to mid-treatment and the reduction in fatigue stress (P <0.001) and pain disorder (P = 0.01) before and after treatment. In addition, a decrease in fatigue stress before to mid-treatment was significantly associated with a decrease in the severity of depressive symptoms before to after treatment (P = 0.04), but not with a decrease in pain interference before to after treatment (P =) .12). There was no association between a reduction in pain disorders before and during treatment and a reduction in depression (P = 0.11) or fatigue stress (P = 0.11) before and after treatment.

The limitations of the study included the exploratory nature and the inclusion of predominantly female (86.4%) and non-Hispanic (84.4%) participants.

The study’s researchers concluded that future research “should investigate whether and how early treatment of depressive symptoms in multi-symptom interventions in people with MS reduced fatigue and pain disorders and depressive symptoms.”


Knowles LM, Arewasikporn A, Kratz AL, Turner AP, Alschuler KN, Ehde DM. Early treatment improvements for depression are associated with general improvements in the effects on fatigue and pain disorders in adults with multiple sclerosis. Ann Behav Med. Published online November 16, 2020. doi: 10.1093 / abm / kaaa102

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