Pain, Fatigue and Depression in Patients with Neuromyelitis Optica Spectrum Disorder in Europe and USA

Objective: Our aim was to investigate the frequency and severity of neuropathic pain, fatigue and depression in neuromyelitis optica spectrum disorder (NMOSD) patients at two major clinical research centers in Europe and USA. Background: NMOSD is an autoimmune disorder of the central nervous system that predominantly causes optic neuritis and transverse myelitis. The relationship among pain, fatigue and depression has not been well characterized in this population. Methods: We included 67 NMOSD patients from two observational NMOSD studies conducted at the Charite Hospital (Berlin, Germany) and the Johns Hopkins Hospital (Baltimore, MD, USA). We used the Beck Depression Inventory (BDI) to evaluate depressive states and the Fatigue Severity Scale (FSS) to evaluate fatigue. Scores from the Brief Pain Inventory and the Pain Detect Questionnaire were normalized to estimate pain. Presence/absence of pain, fatigue and depression was classified on established cut-off values. Correlational and regression analyses were performed to investigate associations between demographic and clinical variables. Results: Among NMOSD patients in the combined cohort, 48[percnt] endorsed significant neuropathic pain, 58[percnt] had a BDI score ≥ 17, indicating possible clinical depression, while 22[percnt] had a BDI score > 20 consistent with moderate to severe depression; 65[percnt] of NMOSD patients had an FSS score consistent with significant fatigue. FSS scores were strongly and significantly correlated with normalized pain scores. Patients with clinically significant pain had on average 0.7 points higher FSS and 2 points higher BDI scores than those classified without pain. NMOSD patients with depression (BDI>=17) had on average 1.5 points higher FSS scores. Conclusions: NMOSD patients suffer from comorbid pain, depression and fatigue. Our analyses indicate that pain is a significant and independent factor of fatigue, while fatigue is a significant and independent factor of depression. Our study suggests that treating pain and fatigue may improve depressive symptoms. Disclosure: Dr. Chavarro has nothing to disclose. Dr. Mealy has nothing to disclose. Dr. Pache has nothing to disclose. Dr. Lacheta has nothing to disclose. Dr. Ruprecht has received personal compensation for activities with Bayer Healthcare, Biogen Idec, Merck Serono, Sanofi/Genzyme, Teva, Roche, and Novartis. Dr. Simpson has nothing to disclose. Dr. Paul has received personal compensation for activities with Teva Neuroscience, Sanofi-Aventis Pharmaceuticals, Inc., Bayer Schering Pharma, Merck Serono, Biogen Idec, Medimmune, and Novartis. Dr. Brandt has received personal compensation for activities with Meedical (Medical GmbH Medizintechnik) as cofounder and director. Dr. Brandt has received personal compensation for activities with Heidelberg Engineering as a speaker. Dr. Brandt has recei Dr. Levy has received personal compensation for activities with Alexion, Guidepoint Global, and Genzyme. Dr. Levy has received research support from Acorda Therapeutics, Sanofi, Alexian, TG Therapeutics, and TerumoBCT.