Pain acts through fatigue to affect participation in individuals with multiple sclerosis

Qual Life Res. 2016 Feb;25(2):477-491. doi: 10.1007/s11136-015-1098-0. Epub 2015 Aug 9.


Purpose: The symptoms of multiple sclerosis (MS) often cause physical and mental dysfunction, which interferes with a person's ability to participate in life's roles. Identification of the strength of the contributors to participation would help prioritize intervention approaches for its improvement. The objective of this study was to estimate the extent to which pain and other MS-related symptoms, physical function, psychological variables, and individual characteristics predict participation in people with MS.

Methods: This was a cross-sectional study. Study sample was a center-stratified random sample of 188 persons with MS. Subjects completed a battery of self-report and performance-based measures that assessed participation and domains affecting participation. To model the relationships among variables, a conceptual framework based on the Wilson and Cleary model was tested. Structural equation modeling aimed at identification of the predictors of participation within the hypothesized theoretical model.

Results: Fatigue (β = 0.63, p < 0.0001), physical function (β = 0.37, p < 0.0001), and psychological variables (β = 0.15, p = 0.04) were found to be as significant direct predictors of participation. Pain (β = 0.4, p < 0.0001) and age (β = 0.12, p < 0.0001) were significant indirect predictors through fatigue and physical function, respectively. Together these effects explained 88 % of the variance of participation, 35 % of the variance in psychological variables, and 29 % of the variance in physical function.

Conclusion: Fatigue, physical function, pain, and psychological variables were most important contributors for participation in persons with MS.

Keywords: Fatigue; Multiple sclerosis; Pain; Participation; Rehabilitation; Structural equation modeling; Wilson–Cleary model.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Exercise
  • Fatigue / psychology*
  • Female
  • Humans
  • Male
  • Multiple Sclerosis / psychology*
  • Pain / psychology*
  • Pain Measurement / methods*
  • Physical Fitness
  • Quality of Life / psychology*