Abstract Background The impact of disease-modifying therapies (DMT) on chronic pain in multiple sclerosis (MS) is poorly understood. Preclinical research suggests that modulation of sphingosine-1-phosphate pathways involved in inflammation and central sensitization could exert analgesic effects alongside MS relapse prevention, but more clinical data is needed. Objective To compare pain phenotypes, severity, and treatment regimens in persons living with MS (PwMS) using S1PR modulators versus other DMTs. Methods We conducted a secondary analysis of cross-sectional data from a nationwide MS survey. Univariate analyses were used to (t- and chi-square tests) examine associations between DMT class, demographics, disability severity, MS duration, pain outcomes, including pain phenotype (painDETECT Questionnaire for neuropathic pain and American College of Rheumatology Fibromyalgia survey for nociplastic pain), intensity and interference (PROMIS scales), analgesics and comorbidities (PROMIS measures). Results Among 731 participants, 82 used S1PR modulators. S1PR users were younger (48.02 vs. 52.51), but other characteristics were similar. After adjusting for age, pain types were similar in both groups. Among those with nociplastic pain, S1PR patients reported lower pain intensity than those on other DMTs (p = 0.02). Conclusions Compared to other DMTs, S1PR modulators are associated with lower pain intensity in MS patients with nociplastic pain.
Sierra et al. (Fri,) studied this question.