Advertisement
Perspectives in MS
Perspectives in MS

Invisible Symptoms of MS

One of the most personally influential articles I have read on MS was published in The Journal of Neuroscience Nursing in 2008, titled, “Invisible and Visible Symptoms of Multiple Sclerosis: Which are More Predictive of Health Distress?”

The authors of this study surveyed 145 patients with MS to determine whether they were distressed more by visible or invisible symptoms of MS. According to the article, “Visible symptoms include the use of assistive devices, problems with balance, and speech difficulties, while invisible symptoms include fatigue, pain, depression, and anxiety.”

The study found that the large majority of complaints of “health distress” were due to invisible symptoms. The authors state that, “The invisible symptoms of pain and depression were the most significant predictors of distress.” 

Classically, MS has been considered a disease largely without pain.  After all, the brain itself has no sensory receptors, (in fact, many neurosurgical procedures are performed on patients without sedation).  So why should pain be a prominent symptom in patients with MS?  Additionally, though it is not at all surprising that patients with MS might suffer from depression (depression is common in many people without MS, of course), does the distress caused by depression really outweigh the distress caused by trouble walking?  Well, it seems this is the case.

The results surprised me at the time, but I doubt they would surprise too many of my patients with MS.  I have met many patients whose level of suffering is out of proportion with their visible disabilities.  It is a challenge to remind myself that in such patients my eyes and neurological exams can fail to detect what bothers patients them most.  I know that patients are frustrated by this as well.  They are understandably troubled when other people tell them that they look so well, when in fact they might feel quite terrible.

I hope that the lessons of the study become more fully understood by anyone involved in treating MS, and indeed anyone who knows or cares for someone with the disease. Yet, I understand this is a tall order. After all, it is very easy to measure how quickly someone can walk 25 feet, or see if someone is walking with a cane or not.  In contrast, it is very difficult to measure and understand someone else’s depression and pain.  Nonetheless, doctors need to remember that our patients’ most distressing symptoms might be those we never see.

  • 1

Tags: Living With , Symptom Management , MS & Mental Health

Was this article helpful? Yes No

More Articles from Jonathan

  • Goodbye!

    By: Jonathan Howard, MD
    Feb 28, 2012

    Goodbye!!! Unfortunately, this is going to be my last column for now. Let me take this chance to thank the folks at Healthline for giving me the opportunity to write as much as I did. The one requirement I made when I started writing is that n...

    Read more »

  • Vitamin D, Part 2

    By: Jonathan Howard, MD
    Jan 31, 2012

    While the role of a low vitamin D level is a becoming an established risk factor for MS, it is not universally accepted as such. Even less clear is the role for vitamin D supplementation once the diagnosis of MS has been made is less clear. A s...

    Read more »

  • Secondary Progressive MS vs Relapsing-Remitting MS

    By: Jonathan Howard, MD
    Jan 05, 2012

    One of the most common questions I am asked by patients is whether they are in the relapsing-remitting phase of MS or in the progressive phase of the illness. Lets again review what these terms mean. About 85% of patients start the illness wit...

    Read more »

  • Relapses and Disability, Part 2

    By: Jonathan Howard, MD
    Dec 27, 2011

    In my last post I briefly summarized two papers that showed that relapses in MS were only very rarely sources of permanent disability. But does this mean that relapses don’t matter? Does this mean that by using medications to prevent relapses ...

    Read more »

Advertisement

About the Author

Dr. Howard is a neurologist & psychiatrist, and an expert in multiple sclerosis.

Recent Blog Posts

Advertisement
Advertisement