Multiple Sclerosis: Widespread Pain with Nociplastic Features (WPNF) Linked to Low Physical Activity Interview with:
Libak Abou PhD, MPT
Department of Physical Medicine & Rehabilitation
Michigan Medicine
Institute for Healthcare Policy and Innovation
University of Michigan, Ann Arbor, Michigan What is the background for this study?

Response: Chronic pain is a common symptom experienced by persons with multiple sclerosis (MS) that affects their daily living functioning including physical activity. Growing evidence indicates that persons with MS may experience various types of chronic pain including widespread pain with nociplastic features (WPNF), nociceptive pain, and/or neuropathic pain. WPNF is a chronic and diffuse pain which can be challenging to localize or describe precisely. In person with multiple sclerosis, this type of pain arises from altered processing signals within the central nervous system. This is opposed to pain that arises from specific tissue damage, classified as nociceptive pain, or pain related to demyelination and axonal damage, classified as neuropathic pain.

Our main goal with this study was to investigate whether differences exists on the level of physical activity achieved by persons with MS based on the type of chronic pain they experience What are the main findings?

Response: Our key finding is that persons with multiple sclerosis with higher indication of WPNF were more likely to be insufficiently active or sedentary when compared to persons with MS with no chronic pain, nociceptive pain, or neuropathic pain. The study suggests that it is important for clinicians attending persons with MS to consider the type of pain these patients are experiencing as this may be more important than pain intensity with respect to physical activity behavior. What should readers take away from your report?

Response: We strongly suggest that clinicians conduct a screening to identify the underlying pain mechanism that their patients with multiple sclerosis are experiencing. This is an essential first step in providing tailored care to enhance physical activity in patients with MS. A good sense of the underlying pain mechanism for any given patient may be achieved with brief surveys or by asking questions that get at the key features of distinct pain phenotypes. Clinicians should know that individuals with WPNF who initiate a new exercise program are likely to experience an initial increase in pain until exercise becomes habitual; this immediate experience of worse pain may present a significant barrier to establishing a regular exercise routine. These patients will likely need extra support, from a physical therapist or similarly qualified professional, to plan and execute a slow, graded increase in physical activity that sets expectations for long-term improvements in symptoms and function even in the face of short-term pain exacerbations. What recommendations do you have for future research as a result of this study?

Response: Widespread Pain with Nociplastic Features is a relatively recent concept and we are trying to better understand how it affects persons with MS. The next step we are working on is to replicate the findings of this study using quantitative measurement of physical activity, for example daily step counts. Future studies could also work on understanding how WPNF affects falling and other factors important to people with MS, such as maintaining functional independence.

In the future, it will also be important to design and test an evidence-based behavioral intervention to enhance physical activity and improve the functioning of persons with MS with WPNF.

No disclosures.


Widespread Pain With Nociplastic Features is an Independent Predictor of Low Physical Activity in People with Multiple Sclerosis
Abou, Libak et al.
The Journal of Pain, Volume 25, Issue 2, 418 – 427

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Last Updated on January 22, 2024 by