“I know only one thing: that I know nothing.” This quote, attributed to Socrates, seems contradictory at first glance. It also challenges our reliance on the gradual accumulation of a body of medical and scientific knowledge over the centuries, and on years of study and clinical or research experience throughout our professional life. It would be easy to dismiss this statement as the ramblings of a philosopher with questionable academic standing, and zero publications. . . . Yet, Socrates simply entices us to allow our beliefs and dogmas to be challenged, through observation and critical thinking. I am hopeful that, in reading the articles published in this issue of the International Journal of MS Care, you will find opportunities to both validate your empirical experience and be intrigued by new and unexpected findings.
Patients' opinions often challenge clinicians' views, yet these opinions will drive their decisions and attitudes toward MS and the various treatments offered to them. In this issue, Wilson and colleagues report on patient preferences regarding attributes of disease-modifying therapies (DMTs) for MS. Not surprisingly, patients express a preference for medications administered orally, which may improve their symptoms and delay the progression of disability. Their interest in a DMT's impact on magnetic resonance imaging findings of disease activity may be a reflection of educational efforts by clinicians with regard to the value of imaging in the monitoring of MS. It is surprising that the effect of medications on relapse frequency, which remains the primary outcome in many pivotal randomized clinical trials, does not seem to influence patients' choice of medication. Once patients have chosen a DMT, maintaining treatment adherence over time is the next challenge. The article by DuChane et al. illustrates how specialty pharmacies, through targeted patient screening and support and by alerting the prescribers when needed, can become partners in the multidisciplinary care of patients with MS. The treatment management program presented here was successful, even in the presence of known factors interfering with adherence, such as fatigue or depression.
Similar to treatment adherence, helping patients increase and maintain their level of physical activity is an ongoing effort that requires intervention between visits with the treating provider. Motl and his team have designed an Internet-based program to promote physical activity (PA) behavior, combining educational content with one-on-one coaching sessions. Beyond demonstrating overall treatment efficacy, their analysis shows that patients with lower disability, relapsing-remitting course, and normal weight are more likely to benefit from the intervention. The need for well-structured, theory-based online behavioral programs supported by high-quality evidence is underscored by the gap in information on behavioral techniques to enhance PA identified by Shirazipour and colleagues in their examination of 20 websites.
Central neuropathic pain and mood disturbance are common symptoms of MS and can have a profound impact on patients' quality of life. While screening for and treating depression is now common practice in the comprehensive management of MS, anxiety—which may be more prevalent than depression—has not been as thoroughly studied. Thanks to the information provided by Terrill and colleagues on the psychometric properties of the 7-item Generalized Anxiety Disorder (GAD-7) scale, researchers and health-care providers can more confidently use this simple tool to assess anxiety symptoms in MS patients. The article from Brown and Slee contributes to filling a critical gap in evidence regarding symptomatic therapies for pain in MS by demonstrating the efficacy of duloxetine in reducing average and worst pain of central origin compared to placebo, and by providing information on the nature and frequency of side effects associated with the medication.
The annual meeting of the Consortium of Multiple Sclerosis Centers is only 2 months away. Our editorial team will be offering a course on manuscript writing and ethical issues related to scholarly publication. We look forward to seeing you in Indianapolis!