Pain outcomes in persons with multiple sclerosis receiving S1PR modulators: a cross-sectional study

The impact of disease-modifying therapies (DMTs) on chronic pain in multiple sclerosis (MS) is poorly understood. Preclinical research suggests that modulation of sphingosine-1-phosphate pathways involved in inflammation and central sensitization could exert analgesic effects alongside MS relapse prevention, but more clinical data are needed.

To compare pain phenotypes, severity, and treatment regimens in persons living with MS using sphingosine-1-phosphate receptor (S1PR) modulators versus other DMTs.

We conducted a secondary analysis of cross-sectional data from a nationwide MS survey. Univariate analyses (t- and chi-squared tests) were used to examine associations among DMT class, demographics, disability severity, MS duration, pain outcomes (including pain phenotype [via the painDETECT Questionnaire for neuropathic pain and the American College of Rheumatology Fibromyalgia Survey for nociplastic pain], intensity, and interference comorbidities (PROMIS surveys), and analgesic therapies.

Among 731 participants, 82 used S1PR modulators. S1PR users were younger (48.02 vs 52.51 years), but other characteristics were similar. After adjustment for age, pain types were similar in both groups. Among those with nociplastic pain, S1PR patients reported lower pain intensity than did those on other DMTs (P = .02).

Compared with other DMTs, S1PR modulators are associated with lower pain intensity in patients with MS with nociplastic pain.