Invisible symptoms and associated factors in multiple sclerosis patients

Background: The invisible symptoms and associated factors have remained controversial especially about the effect of invisible symptoms on the Expanded Disability Status Scale (EDSS) and the daily life of individuals with multiple sclerosis (MS) patients. So, this study aimed to determine the invisible symptoms and associated factors in MS patients. Materials and Methods: This cross-sectional study analyzed data from 155 patients with MS registered at a referral clinic in Kerman during 2023–2024. Regression was utilized to identify factors associated with the invisible symptoms (fatigue, mood disorder, cognitive impairment, pain, and sexual dysfunction). Results: Out of 155 participants in the study, 135 were women (87.1%). The average MS disease duration for these subjects was 9.0 ± 5.5 years. The most common invisible symptoms were fatigue and mood disorder. According to the regression results, the EDSS component had a positive association with sexual impairment (B = 0.559), and women had more sexual impairment than men (B = 0.516). Age and EDSS had a negative association with mood disorder and quality of life (B = -0.269 and B = -0.695, respectively). EDSS had positive association with fatigue intensity (B = 0.259), additionally physical disease and EDSS showed significant positive association with the Pain Disability Index (B = 0.224, B = 0.270, respectively). Having physical disease increased cognitive impairment (B = 1.051). Conclusion: The findings suggest that EDSS is associated with almost all aspects of the invisible symptoms in people with MS, except cognitive impairment. Also, the more physical disease one has, the more pain and cognitive impairment one may experience.