title: An Empirical Investigation of a Biopsychosocial Model of Pain in Multiple Sclerosis.
abstract: OBJECTIVE
  Pain is a significant problem for many individuals with multiple sclerosis (MS). Pain is often associated with other MS symptoms (eg, physical, sensorimotor, cognitive declines), and both pain and MS symptoms are hypothesized to contribute to psychosocial problems (eg, depression), other symptoms (eg, fatigue, sleep disturbance), and functional impairments (eg, pain interference). On the basis of a biopsychosocial model, we sought to: (1) examine the associations between pain, MS symptoms, depression, psychosocial, and functional variables and (2) identify possible risk and protective factors associated with pain in MS.
  
  
  METHODS
  A cross-sectional survey was completed by 424 individuals with MS. Pain, MS symptoms, demographics, MS diagnostic factors, and psychosocial and functional variables were assessed. Data were analyzed by structural equation models.
  
  
  RESULTS
  Participants were predominantly white (92%), middle-aged (mean=50.7 y), and female (80%). Results indicated that pain severity and depression accounted for >50% of the variance in pain interference. Although pain contributed minimally to fatigue and sleep quality, depression and MS symptoms predicted 49% of the variance in fatigue, and depression was largely responsible for the 40% of predicted variance in sleep quality. Identified risk factors for pain were low educational attainment and lack of a committed/marital relationship, even while controlling for diagnostic and other key demographic variables.
  
  
  CONCLUSIONS
  Results highlight the importance of targeting interventions toward improving coping skills and social support within the context of pain and MS. Research is needed to determine whether effectively targeting depression in MS results in improvements of other critical psychosocial and physical functioning domains.
authors.affiliation: *School of Psychology, The University of Queensland, Brisbane, Qld, Australia†Department of Rehabilitation Medicine, University of Washington§VA Puget Sound Health Care System, Seattle, WA‡Psychology Service, VA Medical Center, Tuscaloosa, AL∥VA MS Center of Excellence, West, Seattle.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Day
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Ehde
authors.forename: L Charles
authors.initials: LC
authors.lastname: Ward
authors.forename: Narineh
authors.initials: N
authors.lastname: Hartoonian
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Alschuler
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Turner
authors.forename: George H
authors.initials: GH
authors.lastname: Kraft
authors.forename: Mark P
authors.initials: MP
authors.lastname: Jensen
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology*; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology*; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D057566:Self Report; D055815:Young Adult