Understanding the co-occurrence of pain and depression in adults with multiple sclerosis

While depression and pain are two of the most common problems experienced by persons with multiple sclerosis (MS), the prevalence of their comorbidity is not well understood. Prior studies have reported that rates of depression are high among persons with pain and vice versa, but there is an absence of studies describing the pain-depression comorbidity in a sample of persons with MS that is not limited only to those who are depressed or in pain. Thus, the purpose of the present study was to define this co-occurrence in a community sample of persons with MS. Participants (N = 161) with MS completed the Patient Health Questionnaire–9 for depressive symptoms and Numerical Rating Scale (0-10) for pain. Two definitions of depression (PHQ-9 >= 10 and meeting Major Depressive Episode (MDE) diagnostic criteria) and pain (presence of any pain and pain >= 3) were used for analyses. Pain was experienced by 73% of the sample, with 40% of the entire sample reporting pain >= 3. PHQ-9 scores >= 10 were reported by 22% of the sample, and 8% reported sufficient symptoms to meet MDE criteria. Of persons meeting depression criteria, 86%-100% reported experiencing any pain; 67%-77% of persons meeting depression criteria reported experiencing pain of at least moderate severity. Of persons experiencing any pain, 11%-34% met depression criteria; 15%-37% of persons experiencing pain of at least moderate severity met depression criteria. Taken together, the results show that pain and depression often co-occur, but that this co-occurrence is highest among the subset of the population that is depressed. Prevalence rates also vary significantly with the use of different criteria for pain or depression. The implications of having comorbid pain and depression relative to either condition alone is worthy of further exploration. Support provided by NIH/NICHD/NCMRR (P01-HD33988) and National Multiple Sclerosis Society (MB-0008).