Pain affects depression through anxiety, fatigue, and sleep in multiple sclerosis.

TitlePain affects depression through anxiety, fatigue, and sleep in multiple sclerosis.
Publication TypeJournal Article
AuthorsAmtmann D, Askew RL, Kim J, Chung H, Ehde DM, Bombardier CH, Kraft GH, Jones SM, Johnson KL
JournalRehabil Psychol
Date Published2015 Feb
Anxiety Disorders, Chronic Pain, Cross-Sectional Studies, Depressive Disorder, Fatigue, Female, Humans, Male, Middle Aged, Multiple Sclerosis, Quality of Life, Sleep Wake Disorders, Surveys and Questionnaires

OBJECTIVE: Over a quarter million individuals in the United States have multiple sclerosis (MS). Chronic pain and depression are disproportionately high in this population. The purpose of this study was to examine the relationship between chronic pain and depression in MS and to examine potentially meditational effects of anxiety, fatigue, and sleep. METHOD: We used cross-sectional data from self-reported instruments measuring multiple symptoms and quality of life indicators in this study. We used structural equation modeling to model direct and indirect effects of pain on depression in a sample of 1,245 community-dwelling individuals with MS. Pain interference, depression, fatigue, and sleep disturbance were modeled as latent variables with 2 to 3 indicators each. The model controlled for age, sex, disability status (Expanded Disability Status Scale), and social support. RESULTS: A model with indirect effects of pain on depression had adequate fit and accounted for nearly 80% of the variance in depression. The effects of chronic pain on depression were almost completely mediated by fatigue, anxiety, and sleep disturbance. Higher pain was associated with greater fatigue, anxiety, and sleep disturbance, which in turn were associated with higher levels of depression. The largest mediating effect was through fatigue. Additional analyses excluded items with common content and suggested that the meditational effects observed were not attributable to content overlap across scales. CONCLUSION: Individuals living with MS who report high levels of chronic pain and depressive symptoms may benefit from treatment approaches that can address sleep, fatigue, and anxiety.

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What was this research about?

Chronic pain is common for people who have multiple sclerosis (MS). Chronic pain can be frequent, and may not go away. When pain is bad enough to limit our daily activities, it can sometimes make us feel down or depressed, also called “low mood.” In this study, we wanted to figure out how chronic pain contributes to lower mood. We looked to see if pain changes mood directly.  We also wanted to know if pain changes mood indirectly by increasing:

  1. Anxiety (feeling stressed or worried)
  2. Fatigue (feeling exhausted or worn out)
  3. Sleeping problems

What did the researchers do?

We sent surveys to a large number of people with MS, and more than 1,200 people filled out our surveys. We asked questions about how much pain they experienced and how much the pain got in the way of doing things like working, socializing or running errands. We also asked about experiences with anxiety, fatigue, trouble sleeping, and feeling depressed.

What did the researchers find?

People with more pain also reported lower mood. In addition, people who had more pain also reported more anxiety, fatigue, and trouble sleeping. All three of these symptoms, in turn, were related to feeling more depressed. Instead of lowering mood directly, chronic pain can lower our mood by causing anxiety, fatigue, and trouble sleeping. Of the three symptoms (anxiety, fatigue and sleep) pain’s impact on fatigue was most strongly related to lower mood. This is useful for researchers to know because it suggests that treating fatigue may be a good way to improve mood.

How can you use this research?

If you have chronic pain, you may be able to improve your mood by reducing stress, managing your energy, and improving your sleep. Here are some tips:

  • Pace yourself. Slowing down and taking rest breaks can help reduce stress and keep you from getting too tired.
  • Mindfulness meditation can reduce anxiety by helping you focus on the present moment. Learn more about mindfulness meditation at here.
  • Being physically active is a great way to stay energized, stave off stress, and sleep better at night. For more information, check out our fact sheet on How to Stay Physically Active.
  • Many people find that taking short naps during the day help save energy. However, napping for too long can make it harder to sleep well at night.
  • Practice good sleep habits by waking up and going to bed around the same times each day. Try to follow a regular bedtime routine, and avoid alcohol and caffeine before bedtime.
  • If you have chronic pain along with anxiety, fatigue or sleep problems, counseling approaches such as cognitive-behavioral therapy can help you learn how to manage these issues at the same time.

What you need to know:

  • People with chronic conditions have a higher risk of becoming depressed. If you think that you or a loved one might be feeling depressed, check out our fact sheet on How to Cope with Depression.
  • Reducing fatigue can improve your mood and quality of life. Check out our fact sheet on How to Manage Your Energy.
  • Sleeping well can also improve your mood and quality of life. Check out our fact sheet on How to Sleep Better.
PubMed ID25602361