Psychology in neuromyelitis optica, transverse myelitis, and multiple sclerosis: a cross-sectional study of fatigue, pain, and depression associated with disability

Abstract

Multiple sclerosis (MS), neuromyelitis optica (NMO), and transverse myelitis (TM) are devastating autoimmune neuroinflammatory disorders that produce varying levels of disability. The presence of psychological symptoms including depression, fatigue, and pain has been long documented and researched in MS patients. Only recently have few studies begun to estimate the prevalence of depression, fatigue, and pain in NMO patients, and no existing literature focuses on the psychological burden of TM. Our research question focused on the prevalence of these psychological issues in NMO, TM, and MS patients, and how disability relates to depression, fatigue, and pain in these disease groups. We developed a research study using a survey format where NMO, TM, and MS participants completed a series of online surveys assessing disability, depression, fatigue, and pain. We used the patient-administered Expanded Disability Status Scale (EDSS) to assess disability, the Beck Depression Inventory (BDI) to assess depression, the Fatigue Severity Scale (FSS) to assess fatigue, and the short form Brief Pain Inventory (BPI) to assess pain. In all, 15 NMO, 14 TM, and 23 MS patients participated in the study. While we did not find a significant difference between disease groups on any outcome measure in this limited sample size, we did observe several trends. First, NMO and TM patients had higher levels of disability and pain severity than MS patients, yet MS and TM patients displayed more fatigue and depressive symptomatology than NMO patients. Relationships between disability scores and the psychological outcome variables (BDI, FSS, and BPI scores) were assessed by correlational analysis. We found that disability correlated with measures of depression (r = +0.56), fatigue (r = +0.42), pain severity (r = +0.50) and pain interference (r = +0.42) in the MS group.