Pain, depression, and quality of life in adults with MOG-antibody–associated disease

Background and purpose Myelin oligodendrocyte glycoprotein-antibody–associated disease (MOGAD) is an inflammatory autoimmune condition of the central nervous system. However, data on pain and depression have remained scarce. The aim of this study was to assess features of chronic pain and depression as well as their impact on health-related quality of life (hr-QoL) in MOGAD. Methods Patients with MOGAD were identified in the Neuromyelitis Optica Study Group registry. Data were acquired by a questionnaire, including clinical, demographic, pain (PainDetect, Brief Pain Inventory–Short Form, McGill Pain Questionnaire–Short Form), depression (Beck Depression Inventory-II), and hr-QoL (Short Form-36 Health Survey) items. Results Twenty-two of 43 patients suffered from MOGAD-related pain (11 nociceptive, eight definite neuropathic, three possible neuropathic) and 18 from depression. Patients with neuropathic pain had the highest pain intensity and most profound activities of daily living (ADL) impairment. Fifteen patients reported spasticity-associated pain, including four with short-lasting painful tonic spasms. Later disease onset, profound physical impairment, and depression were associated with chronic pain. Physical QoL was more affected in pain sufferers ($\it p$ < 0.001) than in pain-free patients, being most severely reduced by neuropathic pain ($\it p$ = 0.016). Pain severity, visual impairment, and gait impairment independently predicted lower physical QoL. Depression was the only factor reducing mental QoL. Twelve patients still suffering from moderate pain (pain severity 4.6 $\pm$ 2.3) received pain medication. Only four out of 10 patients with moderate to severe depression took antidepressants. Conclusions Being highly prevalent, pain and depression strongly affect QoL and ADL in MOGAD. Both conditions remain insufficiently controlled in real-life clinical practice