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Published on: December 9, 2015
Multisite chronic pain and incident multiple sclerosis: A prospective cohort study
Fatemeh Vazirian1, Jing Tian1, Jane Alty2
1Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia.
Background:
Chronic musculoskeletal pain is common in multiple sclerosis (MS) and pain-inflammation pathways may contribute to neurodegeneration; however, whether chronic pain is associated with later MS remains unclear. This study examined associations between chronic pain and incident MS, and whether inflammation mediates this relationship.
Methods:
Data from 356,010 UK Biobank participants free of MS at baseline were analysed. Chronic pain (≥3 months) in the hip, neck/shoulder, back, knee, or all over the body was documented. Participants were grouped as having no chronic pain, one or two pain sites, three or four sites, and pain all over the body. Incident MS was determined and Cox regression estimated associations between chronic pain and incident MS. Mediation analysis assessed the contribution of systemic inflammation.
Results:
Over a median 13-year follow-up, 1,007 participants developed MS. In multivariable analyses, chronic pain was associated with a 26% increased risk of MS compared with those without chronic pain (HR 1.26; 95% CI, 1.10-1.43). A dose-response relationship was observed, with risk increasing by number of pain sites (HR 1.44; 95% CI, 1.32-1.57), and pain all over the body conferred a nearly 4.9-fold higher risk. Partial mediation by inflammation was observed (INFLA-score 1.23%, C-reactive protein 1.77%, white blood cells -0.48%).
Conclusion:
Chronic musculoskeletal pain was associated with later MS, particularly when involving multiple sites. The association was partly mediated by peripheral inflammation, suggesting that chronic pain may serve as an early marker of MS, and that both conditions may reflect different manifestations of a shared underlying neuroimmune process.
Insights
Chronic musculoskeletal pain is linked to a higher risk of developing multiple sclerosis (MS). This association, particularly with widespread pain, is partly explained by inflammation, suggesting a shared neuroimmune process.
Area of Science:
- Neuroimmunology
- Epidemiology
- Pain Medicine
Background:
- Chronic musculoskeletal pain is prevalent in multiple sclerosis (MS) and may influence neurodegeneration.
- The relationship between chronic pain and the subsequent development of MS is not well understood.
Purpose of the Study:
- To investigate the association between chronic pain and the incidence of MS.
- To determine if systemic inflammation mediates the relationship between chronic pain and MS.
Main Methods:
- Analysis of UK Biobank data from 356,010 participants without MS at baseline.
- Categorization of participants based on the number of chronic pain sites (≥3 months).
- Cox regression and mediation analysis to assess associations and the role of inflammation.
Main Results:
- Chronic pain was associated with a 26% increased risk of developing MS.
- A dose-response relationship was observed, with pain in multiple sites significantly increasing MS risk.
- Inflammation partially mediated the association, with varying effects across inflammatory markers.
Conclusions:
- Chronic musculoskeletal pain is a significant predictor of later MS diagnosis, especially when widespread.
- Peripheral inflammation plays a partial role in this association.
- Chronic pain may indicate an early risk for MS, reflecting shared neuroimmune pathways.
