Impact of pain subtypes on disability and quality of life in multiple sclerosis: Neuropathic pain demonstrates the strongest association.

BACKGROUND

Pain is a common and disabling symptom in multiple sclerosis (MS) and may arise from different mechanisms. Among pain subtypes, neuropathic pain (NP) and musculoskeletal pain (MSP) are the most frequent, yet their differential clinical and functional associations remain insufficiently characterized.

OBJECTIVE

To compare the prevalence, anatomical distribution, and clinical characteristics of pain subtypes in people with MS (pwMS) and to examine differences in disability and health-related quality of life (HRQoL) across these subgroups.

METHODS

This cross-sectional study included 1503 pwMS followed at the Multiple Sclerosis Center of Izmir University of Economics Medical Point Hospital. PainDETECT and the Nordic Musculoskeletal Questionnaire were used to classify participants into three groups: no pain, MSP, and NP. Disability was measured using the Expanded Disability Status Scale (EDSS), and HRQoL was assessed with the EQ-5D-3 L and EQ-VAS.

RESULTS

Pain was reported by 68.2% of participants, with 17.7% classified as NP and 50.5% as MSP. Participants with NP had higher disability (median EDSS = 2.0) than those with MSP or no pain (p < 0.001). HRQoL scores were significantly lower in the NP group across all EQ-5D domains and EQ-VAS (p < 0.001), while MSP was associated with moderately reduced HRQoL.

CONCLUSION

NP was linked to greater disability and poorer HRQoL compared with MSP or the absence of pain. These findings underline the importance of routine screening for pain subtypes in MS and support early, targeted interventions to reduce their functional and psychosocial burden.