Clarifying the nature of the pain – depression relationship in multiple sclerosis


Amtmann, D., Askew, R. L., Kim, J., Chung, H., Ehde, D. M., Bombardier, C. H., Kraft, G. H., Jones, S. M., & Johnson, K. L. (2015). Pain affects depression through anxiety, fatigue, and sleep in multiple sclerosis. Rehabilitation Psychology, 60(1), 81-90.


Researchers have documented the relationship between pain and depression, but the mechanism by which pain can exhibit its effect on depression is less clear. This cross-sectional study examined anxiety, fatigue, and sleep as potential mediating variables between chronic pain and depression in people living with multiple sclerosis (MS), a population that tends to exhibit elevated levels of both pain and depression. A total sample of 1,271 people living with MS completed surveys that were mailed to their homes. Participants were predominately women, White, partnered, and employed. Findings of structural equation modeling suggest that pain exerts its impact on depression indirectly through increased levels of anxiety, fatigue, and sleep, accounting for approximately 80% of the variance in depression.  The researchers discuss important clinical implications, for example the potential importance of targeting symptom clusters in treatment versus choosing treatment strategies based on one targeted problem.

I CHOSE THIS ARTICLE BECAUSE it brings us a step closer to clarifying the nature of the pain – depression relationship in a population where these concerns commonly present in clinical settings. It makes a nice case for employing comprehensive treatment approaches to perhaps more effectively manage symptoms and may also speak to the need for interdisciplinary care in medical settings.

THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chosen by Abbey Valvano, Ph.D., Baylor Institute for Rehabilitation.