Faculty Collaboration Database

Perceived pain during isometric exercise and neuromuscular fatigability in individuals with multiple sclerosis. Mult Scler Relat Disord 2026 Mar;107:106943

Date

12/28/2025

Pubmed ID

41455296

DOI

10.1016/j.msard.2025.106943

Scopus ID

2-s2.0-105025747372 (requires institutional sign-in at Scopus site)

Abstract

Among people with multiple sclerosis (PwMS), pain is a common symptom, and neuromuscular fatigability is widely reported. However, the association between pain during exercise and neuromuscular fatigability remains unclear. This study aimed to identify the association between perceived pain and neuromuscular fatigability during an exercise task in PwMS. Thirty-two PwMS (age=56.4, females=15) and 15 age- and sex-matched non-MS controls (age=57.9, females=7) participated. Disease severity was evaluated using the Expanded Disability Status Scale (median EDSS=4.0). The experimental protocol involved maximal voluntary contractions (MVCs) of the dorsiflexors, time-to-task failure (TTF) of an isometric fatiguing exercise sustained at maximal strength (neuromuscular fatigability), and a post-exercise MVC. Central and peripheral fatigability were assessed using electrical stimulation. The twitch interpolation technique quantified voluntary activation (VA), with pre-to-post exercise reductions in VA indicating central fatigability. Pre-to-post exercise reductions in resting twitch amplitude indicated peripheral fatigability. Perceived pain (0-10) was assessed at rest prior to exercise, during, and immediately post-exercise. Associations of changes in pain perception were identified using Spearman's correlation coefficient (rho). Despite no significant differences between PwMS and controls across all outcome measures (p > 0.2), compared to controls, PwMS with higher disease severity (n = 12, EDSS≥4.5) had a significantly shorter TTF (mean difference=-38.5 s, p = 0.04), higher central fatigability (11 percentage points, p = 0.01), and lower peripheral fatigability (-20.8%, p = 0.01). Among PwMS, smaller changes in pain perception correlated with increased neuromuscular fatigability (rho=0.5, p = 0.003), higher central fatigability (rho=-0.4, p = 0.05), and lower peripheral fatigability (rho=0.4, p = 0.03). These findings suggest that perceived pain during the exercise task may be an overlooked mechanism contributing to neuromuscular fatigability in PwMS.

Author List

Rouhani M, Bement MKH, Hunter SK, Zackowski KM, Obeidat AZ, Ng AV

Author

Ahmed Zayed Obeidat PhD, MD Associate Professor in the Neurology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Exercise
Female
Humans
Isometric Contraction
Male
Middle Aged
Multiple Sclerosis
Muscle Fatigue
Muscle, Skeletal
Pain
Pain Perception
Severity of Illness Index