Studies Investigate Best Practices in MS Treatment and Effects of Pain

Most individuals with multiple sclerosis (MS) experience pain as a symptom of the disease. Two recent studies presented at the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers investigated pain and how the disease is treated, overall.

One study¹ used predictive modeling to determine factors that influence healthcare providers (HCP) practice behaviors to gain a better understanding of barriers preventing the best practice implementation. The researchers used educational outcomes data from an educational activity on MS, which involved a faculty-led webcast with audio recordings of patient feedback and insights into management challenges obtained through interviews. Surveys were also conducted 3 months after the activity that assessed knowledge, confidence, and behavior.

In addition, an analysis was conducted on the preactivity survey, which asked 2 behavior questions related to utilizing a point-of-care decision tool and on how they select treatment based on mechanisms of action and safety profile.

In total, more than 1800 HCPs participated in the activity, and 258 participated in the presurvey. The findings demonstrated that confidence was the strongest predictor of behavior, as those who were less confident were less likely to perform practice behaviors. In terms of a secondary predictor, specialty only affected those who were less confident, with neurologists outperforming primary care providers and other specialists.

“Results from the PredictCME analysis suggest that building HCP confidence is an important component of ensuring best practices are performed for the management of patients with MS. While it is expected that neurologists are more likely to perform optimal behaviors than [primary care physicians] or other specialists, targeting education to, and building confidence for, both neurologists and non-neurologists is essential,” concluded the authors.

Another study² specifically evaluated patients with MS who experience pain. The study aimed to determine the extent to which pain is experienced as an intrusive problem among their total experience with MS-related challenges.

The researchers recruited 161 patients with at least mild pain from the North American Research Committee on MS (NARCOMS) Registry. Participants’ illness intrusiveness was measured with the Illness Intrusiveness Ratings Scale (IIRS) and an analysis was conducted with disability and pain severity as covariates.

The results revealed that MS-related and pain-related IIRS were highly associated with one another. Additionally, MS patients viewed their pain as a significant disruptive factor in their daily lives, specifically involving active recreation, work, health, and community and civic engagement. After considering the level of disease severity, the study found that pain-related illness intrusiveness was a significant predictor of overall MS-related illness intrusiveness—accounting for 47% of the variance.

“While the association between other factors (eg, emotional distress) and perceived illness intrusiveness has been examined in MS, no study to date has investigated pain-related illness intrusiveness in relation to MS symptoms, more generally,” the researchers wrote.

References

1. Reiter J, Perez J, Tordoff S, Faler W. Factors influencing best practices in treating multiple sclerosis: results from a predictive modeling analysis. Presented at the Annual Meeting of the Consortium of Multiple Sclerosis Centers. May 31, 2018; Nashville, Tennessee. Abstract MC02.

2. Gromisch ES, Kerns RD, Beauvais J. Perceived pain-related illness intrusiveness among persons with multiple sclerosis. Presented at the Annual Meeting of the Consortium of Multiple Sclerosis Centers. May 31, 2018; Nashville, Tennessee. Abstract QL02.