Moving towards a better understanding of pain in multiple sclerosis
May 2022: 'Invisible symptoms' such as pain can be a major cause of distress in people with. MS. We are carrying out research into pain in MS to understand more about it, and how to alleviate it.
People with MS can be affected by a range of symptoms. Despite often being invisible to others, these can be a major cause of distress, and reduce quality of life. In order to improve our care for patients, we need to understand these symptoms better.
We know from our previous work that pain can affect well over half of people with multiple sclerosis. However, there are still huge gaps in our understanding. Why does pain happen in some people with MS and not in others? Could pain be linked to cognitive difficulties - as has been shown in some other painful conditions? What treatments work?
Anne Rowling Clinic researchers led by Dr Peter Foley have recently published a study involving over 40 people with relapsing remitting MS. More than half of them experienced chronic pain. The team collaborated with a range of experts including Edinburgh Imaging and specialists at the University of Oxford. They used psychology assessment and advanced MRI scans to examine brain systems known to be involved in modifying pain. The researchers found that pain-modifying systems may be damaged in people with MS who experience chronic pain. They also found a link to performance in some cognitive tests, which might be relevant for developing future treatments.
In separate work, Dr Foley and colleagues used data from a large clinical trial, the MS-SMART trial, to add to our understanding of effective treatments for pain in MS. MS-SMART, which was led by University College London, studied three different medicines in over 400 people with secondary progressive MS across the UK. While the main results of the trial showed that these treatments didn’t slow brain changes over time, the team wanted to see if they might help pain. They were involved in designing the trial so that the findings could be used efficiently to answer these questions. Unfortunately, the tested treatments did not help pain. Although this result was disappointing, it does add useful information about the best ways to treat pain in MS.
Further studies at the Anne Rowling Clinic and in collaboration with other leading researchers, will help answer more questions about pain in MS. In particular, the FutureMS Phase 2 study will help us address some exciting questions, and is already providing some useful answers. Watch this space!
Related links
- Peter Foley's profile
- Scientific article about investigating chronic pain in MS: Foley P, et al. Coupling cognitive and brainstem dysfunction in multiple sclerosis-related chronic neuropathic limb pain. Brain Communications, 2022. doi:10.1093/braincomms/fcac124.
- Scientific article on testing whether MS-SMART trial drugs help alleviate pain: Foley P, et al. Efficacy of Fluoxetine, Riluzole and Amiloride in treating neuropathic pain associated with secondary progressive multiple sclerosis. Pre-specified analysis of the MS-SMART double-blind randomised placebo-controlled trial. Multiple Sclerosis and Related Disorders, 2022. doi: 10.1016/j.msard.2022.103925.
- Scientific article on the effect of disease-modifying therapy on hidden disability in MS: Glasmacher S, et al. The influence of disease-modifying therapy on hidden disability burden in people with newly diagnosed relapsing-remitting multiple sclerosis. Multiple Sclerosis and Related Disorders, 2022. doi: doi.org/10.1016/j.msard.2022.103837.
- Future MS Phase 2 - project page
- MS-SMART project page
- MS Trust information on pain in MS