Cognitive-behavior Therapy for MS-Related Chronic Pain

Inclusion Criteria

• a confirmed diagnosis of Multiple Sclerosis,
• history of daily pain or discomfort (burning, tingling or other parenthesis) for a period of 3 months immediately prior to enrollment,
• judgment of one of the study neurologists (AL or MK) that the pain reported by the patient is either directly [e.g., pain associated with optic neuritis and neuralgias] or indirectly related [e.g., pain due to painful muscle contractures and spasms] to MS and/or its treatment (persons with pain that is judged to be entirely coincident with MS [e.g., idiopathic low back pain] will not be included),
• documentation of optimal pharmacological management of MS-related pain and confirmation of this judgment by one of the study neurologists,
• continued use of appropriate pharmaceuticals for the management of MS and pain, and
• continued refractory pain despite pharmaceutical intervention as described above (as determined by a pain intensity score 4 on a 0-10 numeric rating scale).

Exclusion Criteria

• pending surgery or interventional anesthesiological procedures for pain,
• currently psychotic or actively suicidal or homicidal,
• current alcohol or substance abuse or dependence,
• presence of other life threatening illnesses,
• the presence of profound cognitive impairment rendering successful participation in CBT or ED impossible,
• the presence of physical disabilities resulting in an inability to attend treatment sessions and/or inability to participate in telephone interventions (e.g., severe dysarthria),
• prior or current psychological treatment for chronic pain,
• two or more documented exacerbations of MS-related symptoms during the past year, and
• current exacerbation of symptoms defined as sudden onset of symptoms within a 24 hour period. Participants experiencing an exacerbation will be included after a one-month period of appropriate treatment or three months after the onset of the exacerbation. The Exacerbation Questionnaire, also described below and developed by Dr. Mohr, one of our co-investigators, will be used to assess and monitor significant exacerbations of MS. The Multiple Sclerosis Functional Composite (MSFC) score described below will be used to determine these later two exclusion criteria.