title: Towards a better understanding of MS pain: a systematic review of potentially modifiable psychosocial factors.
abstract: OBJECTIVE
  Pain is a common symptom of Multiple Sclerosis (MS). Biomedical treatments achieve only modest reductions in pain severity suggesting that this approach may be too narrow. The aim of this systematic review was to assess evidence for associations between modifiable psychosocial factors and MS pain severity and pain interference and use this evidence to develop a preliminary biopsychosocial model of MS pain.
  
  
  METHODS
  Empirical studies of pain in MS utilising standardised pain severity and pain interference measures were included. Online databases (Cochrane, PsychInfo, EMBASE, CINAHL, Medline, Web of Science and World Cat) and reference sections of included articles were searched, and corresponding authors contacted to identify unpublished studies. Information about design, sample size, MS type, time since diagnosis, psychosocial and pain measures and key findings were extracted. Thirty-one studies were assessed for quality and a narrative synthesis was conducted.
  
  
  RESULTS
  Similar to primary chronic pain, most studies reported small to medium associations between several psychosocial factors and pain severity and interference. Pain catastrophizing showed consistently strong associations with pain interference. Preliminary findings revealed a strong correlation between pain acceptance and pain interference. However, fear-avoidance appeared less important in MS, and other forms of behavioural avoidance were not explored.
  
  
  CONCLUSIONS
  A preliminary model of MS pain outlining specific psychosocial factors is presented with a conceptual formulation from both traditional, and contextual, cognitive-behavioural perspectives. Pain catastrophizing, acceptance, and endurance, as opposed to fear avoidance, responses are highlighted as potentially important treatment targets in MS, and directions for future research are outlined.
authors.affiliation: Health Psychology Section, Institute of Psychiatry, 5th Floor Bermondsey Wing, Guy's Campus, King's College London, UK. Electronic address: Anthony.harrison@kcl.ac.uk.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Harrison
authors.affiliation: Health Psychology Section, Institute of Psychiatry, 5th Floor Bermondsey Wing, Guy's Campus, King's College London, UK. Electronic address: Lance.mccracken@kcl.ac.uk.
authors.forename: Lance M
authors.initials: LM
authors.lastname: McCracken
authors.affiliation: Health Psychology Section, Institute of Psychiatry, 5th Floor Bermondsey Wing, Guy's Campus, King's College London, UK. Electronic address: Angeliki.bogosian@kcl.ac.uk.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Bogosian
authors.affiliation: Health Psychology Section, Institute of Psychiatry, 5th Floor Bermondsey Wing, Guy's Campus, King's College London, UK. Electronic address: Rona.moss-morris@kcl.ac.uk.
authors.forename: Rona
authors.initials: R
authors.lastname: Moss-Morris
mesh_terms: D000223:Adaptation, Psychological; D059350:Chronic Pain; D003071:Cognition; D015986:Confounding Factors, Epidemiologic; D016208:Databases, Factual; D005239:Fear; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology; D010146:Pain / Q000209:etiology* / Q000523:psychology; D059408:Pain Management; D012720:Severity of Illness Index
keywords: Correlate; Multiple Sclerosis; Pain; Psychological factors; Psychosocial; Systematic review