• A new study addresses the timing of when certain multiple sclerosis (MS) symptoms occur following diagnosis.
• During the early months, clinically significant pain, fatigue, depression, and anxiety are common.
• Doctors should provide treatment that address multiple symptoms simultaneously to improve quality of life, researchers concluded.

People who are newly diagnosed with multiple sclerosis may find that significant symptoms — including pain, fatigue, depression, and anxiety — can occur in a cluster during their first year following diagnosis, according to a recent study published in the journal Multiple Sclerosis.

Researchers at the University of Michigan and University of Washington based their analysis on data from 230 adults with clinically isolated syndrome (CIS) — a course for MS. Specifically, CIS refers to a first episode of neurologic symptoms that lasts at least 24 hours. Participants self-reported measures of pain, fatigue, depression, and anxiety at six intervals during the first year following detection of their illness. About 7 out of 10 participants were female, the average age was 39, and most — 87 percent — were Caucasian, according to the study.

Half of the investigation subjects revealed having pain, 62.6 percent felt fatigued, 47.4 percent experienced signs of depression, and 38.7 percent indicated they had anxiety.

Although just over one-fifth of all participants had no symptoms, nearly 6 out of 10 said they faced a cluster of two or more afflictions at once in the first year. A total of 21.3 percent exhibited two co-occurring symptoms, 19.1 percent had three, and 17.4 percent experienced four symptoms at the same time.

“We know that these are all symptoms that are prevalent in people with MS, but this shows us that these symptoms are all fairly prevalent even very early after diagnosis,” said Asaff Harel, Ph.D., director of the Multiple Sclerosis Center at Lenox Hill Hospital in New York City, who was not involved in the study. “This research also shows us that co-occurrence of symptoms is common, suggesting a potential common etiology (cause),” Dr. Harel told MyMSTeam.

The most common clusters were of pain and fatigue, as well as pain, fatigue, depression, and anxiety, according to study author Dr. Thomas Valentine, a National Multiple Sclerosis Society rehabilitation research fellow working in the Department of Physical Medicine and Rehabilitation at the University of Michigan. Data demonstrated that whenever a person reported significant levels of pain, depression, or anxiety, they were more likely than not to also have significant levels of fatigue.

Based on these results, the researchers concluded that providers need to routinely screen for co-occurring symptoms.

“The presence of one symptom warrants screening for others, particularly fatigue, and if a patient has more severe disability, it is more likely that they will have these symptoms,” the study authors wrote. “Treatment needs to take this into account. Optimizing symptom management in MS will require treatment approaches that account for the complex relationships between these symptoms and, ideally, treat multiple symptoms concurrently.”

The researchers noted that patient ailments fluctuated over the course of one year, and outcomes suggested that those with mild symptoms were unlikely to see a dramatic increase in symptoms within the first 12 months after disease detection.

Dr. Harel told MyMSTeam that the co-occurrence of multiple symptoms in the same person may speak to common etiologies, with one symptom feeding or interacting with another. “Hence, if we target one of the symptoms, the others may also improve,” he said.