Pain Management and Menopausal Health Outcomes in Multiple Sclerosis.
详细信息
- 作者：Jawahar ; Rachel Hannah.
- 学历：Ph.D.
- 年：2013
- 导师：Masho, Saba W.,eadvisorLapane, Kate L.ecommittee memberHarpe, Spencerecommittee memberOh, Unsongecommittee member
- 毕业院校：Virginia Commonwealth University
- Department：Epidemiology
- ISBN：9781303118838
- CBH：3563531
- Country：USA
- 语种：English
- FileSize：1545567
- Pages：121
文摘
Background: Previous studies have addressed multiple sclerosis MS) symptom management and improved health-related quality of life HrQOL). Yet lowered estrogen levels in post-menopasual women with MS may further worsen physical function and symptomology and not all types of pain management have been examined. Objectives: For post-menopausal women with MS, we evaluated the extent to which smoking is associated with worsened health outcomes and HrQOL, and the extent to which menopausal hormone treatment MHT) improves health outcomes and HrQOL. For all adult men and women with clinically diagnosed MS, we systematically reviewed pharmacological and non-pharmacological strategies for the reduction of pain. Methods: We identified 256 post-menopausal women with MS in the Womens Health Initiative Observational Study and examined changes from baseline to 3 years in activities of daily living, physical activity, SF-36 mental and physical component scales MCS, PCS), and menopausal symptoms. In all adults, experimental studies published after 1965 were included if the sample was not restricted to participants with spasticity or trigeminal neuralgia and participant-reported pain was a primary or secondary outcome. Pain scores were reported as Cohens d. Results: Nine percent of post-menopausal women with MS were current smokers and 51% reported current MHT use. Smoking and MHT use had no effect on physical functioning, activities of daily living, or menopausal symptoms. Women with early age at smoking initiation experienced declines in MCS adjusted &beta； ＜20 vs. &ge； 25 years: -10.50, 95% Confidence Interval CI) -2.1 to -18.1； adjusted &beta； 20-24 vs. &ge； 25 years: -8.81, 95% CI: 0.6 to -17.4), but not in PCS. Relative to never MHT users, ever MHT users had higher MCS scores at year 3 compared to baseline adjusted &beta；: 3.0, 95% CI: 0.4 to 5.6), but no change in PCS. For all adults, transcutaneous electrical nerve stimulation TENS； Cohens d: -3.34), nabixomols Cohens d: -0.61), and dextromethorphan/quinidine Cohens d: -0.22) were reported effective in reducing pain. Conclusions: Smoking prevention efforts should be increased for women with MS. Women with MS may also experience HrQOL gains with MHT, but contemporaneous data on MHT use is needed. TENS may be more effective than pharmacological methods in reducing MS pain.