Over 50% of people with multiple sclerosis (PwMS) report chronic pain, primarily in the legs, low back and head. Chronic pain interferes with daily activities, employment, and quality of life. Nonpharmacologic therapies, including exercise, are important for pain management. Spasticity is a known contributor to MS pain, but the effectiveness of stretching for pain, as commonly prescribed for spasticity, has not been investigated.
To determine the prevalence and location of self-reported chronic pain in PwMS and spasticity, and whether participation in an education and lower extremity stretching program (STC) is associated with greater pain reduction after six months of exercise than a program focused on range of motion (ROM).
65 ambulatory PwMS with lower extremity spasticity were randomly assigned to STC or ROM. Both groups had two 2-hour group sessions and were asked to track their exercise for six months. At baseline, chronic pain prevalence and locations were reported. At baseline and 6 months after the sessions, pain severity and interference were measured with the Brief Pain Inventory – Short Form (BPI-SF). Differences between baseline and 6-month scores for all subjects and within each group were compared with paired t-tests.
At baseline, 52% of subjects (34/65, 13 in STC [39.4%], 21 in ROM [65.6%]) reported chronic pain, most frequently in the lower back (73.5%), legs (70.6%), or lower back and legs (88.2%). Twenty of the 34 who reported chronic pain at baseline completed the BPI-SF at 6 months (8 in STC, 12 in ROM). Although pain severity was not significantly decreased in all subjects combined (mean change = -0.59, 95% CI = -1.49 to 0.32, t = -1.36, p=0.19) or separately in STC (mean change = -1.47, 95% CI = -3.28 to 0.34, t = -1.92, p=0.096) or ROM (mean change = 0.00, 95% CI = -1.0 to 1.0, t = 0.00, p=1.0), pain interference was significantly decreased in all subjects combined (mean change = -1.05, 95% CI = -2.03 to -0.07, t = -2.25, p = 0.037). Similar trends were observed in the two groups (STC mean change -1.86, 95% CI = -3.97 to 0.26, t = -2.07, p=0.08. ROM mean change -0.51, 95% CI = -1.55 to 0.53, t = -1.08, p=0.3).
Exercise may help reduce pain interference in PwMS and spasticity. The impact on pain severity, and the relative impact of stretching and ROM exercises is uncertain. A fully-powered study is needed to better understand the impact of different types of exercise on pain severity and interference in MS.