More than 2.3 million people worldwide have multiple sclerosis (MS). The disease is the leading cause of death, disability and increased medical costs [1]. The prevalence of 61 out of every 100,000 population in Iran indicates an increase in the prevalence of this disease in the country [2].
Although the role of genetic and environmental factors (virus, cigarettes, stress, and nutrition) in the development of MS has been confirmed to some extent, its cause is still unknown.
Common symptoms of MS include a wide range of anesthesia (paraesthesia), weakness, visual disturbances, diplopia, imbalance, gait disorders, dizziness, spasm, ataxia, nystagmus, neuropathic pain, emergency urgency, urinary retention disorders, sexual dysfunction, and cognitive and disability including heat tolerance [11].
In these patients, pain is a common symptom associated with age, sex, duration of illness, and symptoms such as physical, sensory-motor, and cognitive impairment, including sleep disturbance, fatigue, depression, disability, poor quality of life, absenteeism, and impaired sleep [12]. About 50 to 60 percent of MS patients can tolerate the pain. Only about 12% of them experience severe pain and seek medical treatment [14, 13].
Multiple sclerosis pain is often chronic and occurs in the form of muscle spasms and migraine headaches associated with active inflammatory processes, and common painkillers, nonsteroidal anti-inflammatory drugs, narcotic painkillers (such as morphine), and anticonvulsants for tricuspid regurgitation and anticonvulsants [17].
Since chronic diseases such as MS affect all economic, financial, social and emotional aspects of the individual, family and society, medical treatment and control of the course of the disease alone is not enough. Psychologists are able to help them increase their ability to perform daily activities and reduce their social, psychological and economic problems [19].
One way to track distance is through information technology [21]. Peck points out that remote care reduces the costs and facilitates access to care and leads to improved communication and presentation. Also, it eliminates barriers regarding time and distance [22].
The aim of this study was to determine the effect of counseling and telephone follow-up on reducing the severity of pain in MS patients.
 

 

A randomized clinical trial was conducted on 70 MS patients attending the multiple sclerosis Clinic at Sina (Farshchian) Hospital, Hamadan, Iran. A two-month intervention was administered, with phone calls organized as follows: Week 1) two calls revolving around medication schedule Week 2) two calls about a diet plan, Week 3) two calls about the exercise schedule، Week 4) two calls about the role of stress in MS; and Weeks 5 to 8) four weekly reminder calls to ensure patient compliance with the contents delivered within the first 4 weeks. Pain assessment scale was completed before and after the intervention.
The collected data were analyzed by SPSS 16 (SPSS Inc., Chicago, IL., USA), descriptive statistics (mean and standard deviation) and inferential statistics (paired t-test, independent t-test, Chi-square, regression analysis and Fisher test) at a confidence level of 0.95.
Also, this research was approved by the ethics code of IR.UMSHA.REC.1396.183 in the ethics committee of Hamadan University of Medical Sciences.

The mean of pain severity in the experimental group before and after the consultation with telephone follow up was statistically significant (P=0/001). The mean of pain severity in the experimental group after the intervention was reduced to 4.32 with a standard deviation of 0.17. However, the mean and standard deviation of pain in the experimental group also showed a downward trend. The comparison of the mean pain severity in the two groups after the intervention showed a significant difference (P<0.001). The results are illustrated in Tables 1 and 2.
 
Table 1. Frequency distribution of patients referring tp Multiple Sclerosis Clinic Farshchian Sina Hospital Hamadan; Two groups of test and control according to demographic and disease characteristics
 

Table 2. Comparison of mean pain, rejuvenation, clinic, sclerosis, Farshchian Sina Hospital, Hamadan, in two groups: free and control before and after the intervention.

Telephone counseling together with telephone follow-up reduces pain in patients with MS and improves patient health. Therefore, counseling with telephone follows up is recommended in reducing pain intensity of patients.

 

This article is taken from the Master's thesis in Nursing with the number 2017052734161N1 approved by the Research Council of Hamadan University of Medical Sciences and Health Services with the code of ethics IR.UMSHA.REC.1396.183. The authors thank the Research Vice Chancellor of Hamadan University of Medical Sciences, faculty members of the Hamadan Nursing Department, the staff of the Multiple Sclerosis Clinic of Farshchian (Sina) Hospital in Hamadan and the patients of Multiple Sclerosis for their cooperation and support.

 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.