Associations of Chronic Low Back Pain with Disability and Health-Related Quality of Life Outcomes in People with Multiple Sclerosis: A Cross-Sectional Survey Study.
Chronic low back pain (CLBP) is a frequent clinical complaint in people with multiple sclerosis (pwMS); however, its prevalence is inconsistently reported, and its impact remains poorly characterized. This cross-sectional nationwide survey aimed to determine the proportion of pwMS who report CLBP and examine its association with self-reported disability and health-related quality of life (HRQoL) outcomes. A total of 1,106 pwMS completed surveys assessing disability (Patient Determined Disease Steps; PDDS), and HRQoL outcomes. Pain location was assessed using the Michigan Body Map, which asks participants to indicate all body regions where they have experienced persistent or recurrent pain for at least last three months. Based on selection of the lower back region, 49.5% (95% CI: 46.5%-52.4%) were classified as having CLBP. Greater disability was associated with higher odds of CLBP in pwMS (OR=1.21, 95% CI [1.02-1.44], p=0.02). Compared to those without CLBP, pwMS with CLBP had significantly higher pain intensity (B=2.9 [2.08-3.8], p<0.001), pain interference (B=3.9 [2.9-4.9], p<0.001), anxiety (B=.08[0.9-3.2], p<0.001), depression (B=1.9 [0.7- 3.1], p=0.001) and fatigue (B=2.4 [1.4-3.5], p<0.001), as well as lower perceived cognitive function (B= -1.79[-2.8- -0.7], p=0.001). There were no significant associations between presence of CLBP and sleep disturbance (B=0.26, p=0.38), physical activity level indexed by Godin-Shephard leisure-time physical activity questionnaire (OR=0.81, p=0.13) or sedentary behavior indexed by one-day sitting time duration (B=0.09, p=0.95). These findings highlight the high proportion and significance of CLBP in pwMS. PERSPECTIVE: The high proportion and substantial burden of chronic low back pain among pwMS warrant a comprehensive and systematic evaluation of existing management strategies to optimize care and improve patient outcomes.