Pain Medication Use and Perceived Effectiveness in People With Multiple Sclerosis: A Mixed-Methods Study

Individuals with multiple sclerosis (MS) often use multiple medications, but evidence comparing their effectiveness is scarce. This study aims to (a) describe pain medication use and perceived effectiveness, (b) identify factors associated with the total number of pain medications, (c) explore the reasons for stopping and (d) use qualitative data to explore the lived experience of PwMS in relation to pain medication effectiveness and reasons for stopping.

Participants from the Australian MS Longitudinal Study completed a pain survey in 2021 (n = 1691); 26 participants self-nominated to participate in focus groups. Participants with regular pain were asked which pain medications they used, to what extent the medications reduced pain, which medications they stopped using and the reasons for stopping. Quantitative data were analysed using descriptive statistics; negative binomial regression was used to determine factors associated with the total number of medications. Qualitative data were analysed using thematic analysis.

Among 899 participants with regular pain, 87.3% were using pain medication. In terms of perceived effectiveness, 62.3% of all reported medications resulted in 'much improvement', 'very much improvement' or 'complete pain relief'. The medications commonly reported to be effective were opioid-containing medications, cannabinoids, antimigraine medications, a combination of paracetamol and nonsteroidal anti-inflammatory drug (NSAID) products and sedatives. Having more pain types, greater pain severity, being female and greater disability (all p < 0.05) were associated with taking a higher number of medications. Common reasons for stopping a medication were side effects and ineffectiveness. Qualitative data supported the quantitative findings.

Most people with pain used medications, and the effectiveness was acceptable for the majority of people. Despite that, stopping medications until the right ones were found was common, often due to side effects and ineffectiveness. This suggests that, with adjustments to treatment plans, effective pain control is achievable for most PwMS with pain.