More than 2,500 participants with multiple sclerosis from across the world were surveyed about their symptoms, lifestyle and social demographics. Image: Shutterstock.

No smoking, regular exercise, healthy weight and balanced diet could help people with multiple sclerosis to manage their pain.

— By Alice Rolandini Jensen

People with multiple sclerosis (MS) can experience chronic and debilitating pain. This greatly affects their quality of life and symptoms are often accompanied by anxiety, depression and fatigue. A study published in Frontiers in Neurology finds strong links between lifestyle and pain symptoms. It suggests that efforts to exercise regularly, stop smoking, eat healthily and maintain a healthy weight may help those with MS to manage their pain.

Pain killers are not a cure

An estimated 2.5 million people worldwide have multiple sclerosis. The condition affects the nervous system, often causing chronic pain and lack of mobility. People with MS are also at higher risk of developing other conditions such as cardiovascular problems and diabetes, together with anxiety, depression and fatigue.

The pain is normally treated with painkillers, but these can have side effects, are expensive and do not treat the cause of pain. In the search for ways to tackle the cause, Claudia Marck and colleagues at the University of Melbourne, Australia, investigated how lifestyle factors are associated with pain.

“Our study  found strong associations between lifestyle and pain in people with multiple sclerosis,” says Marck. “Smokers are more likely to experience pain, and those that do regular exercise seem less likely to experience pain. We also see strong links between pain and the prevalence of anxiety and depression.”

While this study does not claim this association between pain and lifestyle proves a cause-effect relationship, this is in line with other research showing that healthy lifestyle helps to manage MS symptoms such as fatigue and depression.

A global study

The team recruited more than 2,500 participants with multiple sclerosis from across the world, using social media and MS websites and forums. Participants completed an online survey that contained questions about their symptoms, lifestyle and social demographics. The team analysed this to look for patterns in the data.

Smoking exacerbates pain

Smokers were found to be twice as likely to report substantial pain than non-smokers with MS.

“With smoking, studies have shown a detrimental feedback loop,” explains Marck. “In the long term, smoking has been reported to increase the likelihood of chronic pain. However, in the short term it dulls the pain, so this may motivate people with pain to smoke. Also, smokers, and especially those with depression, find it particularly hard to quit, as stopping smoking can initially increase pain sensitivity.”

Exercise alleviates pain

In line with previous studies, Marck’s work shows that people with multiple sclerosis who engage in more physical activity are less likely to have pain. She notes, “You can interpret this association in two ways. As you might imagine, people are less likely to exercise if they are in pain. But on the other hand, exercise has been shown many times over, to be beneficial in terms of pain symptoms. Increased physical activity can increase pain threshold and tolerance, so reducing the experience of pain.”

In people with MS, the nerves lose their protective myelin coating, but previous studies have shown that exercise has neuroprotective and neuroregenerative effects. Marck adds, “This suggests that exercise can potentially reduce pain caused by damage to the nerves as it promotes brain and nerve health.”

Despite this evidence, Marck is quick to note, “People with MS and pain may be more likely to fear physical activity and avoid doing it as it may cause them more pain. In avoiding physical activity, it is likely that they are making their health outcomes worse in the long term.”

Pain linked to anxiety and depression

The study also demonstrates strong links with pain and the prevalence of anxiety and depression. The team cannot claim that lifestyle factors are the cause of pain or explain the relationship between pain and anxiety or depression. However, due to the strong association between lifestyle and pain observed, and a large body of evidence pointing to overall health benefits, Marck advises that those with multiple sclerosis try exercise therapy, smoking cessation and a healthy diet, and to try to have a healthy weight.

She concludes, “Maintaining a healthy lifestyle can be hard for us all. For those with MS it is even more important as they have a higher risk of having poorer health and developing other conditions. For those who struggle to initiate or maintain healthy lifestyle behaviors, seeking the support of a health professional will be invaluable.”

The team are conducting further studies to understand the links between exercise and pain in those with multiple sclerosis. It is also hoped that these preliminary findings will spark further research and intervention studies to substantiate these observations.

Original research article: Pain in People with Multiple Sclerosis: Associations with Modifiable Lifestyle Factors, Fatigue, Depression, Anxiety, and Mental Health Quality of Life

Corresponding author: Claudia Marck

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