ArticleArchives of physical medicine and rehabilitation2026
Daily Temporal Associations Between Use of Psychoactive Substances and Fatigue, Pain, Stress, and Depressive Symptoms in People With Multiple Sclerosis.
Article in Archives of physical medicine and rehabilitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo examine daily within-person associations between symptoms reported by people with multiple sclerosis (MS) and psychoactive substance use using ecological momentary assessment (EMA).
designThis secondary analysis used EMA data collected 4 times daily for 14 days at baseline and 1-year and 2-year follow-ups.
settingCommunity.
participantsAmbulatory adults with MS (N=258).
main outcome measuresParticipants completed daily EMAs via smartphone, reporting use of psychoactive substances and symptoms. Psychoactive substance use (alcohol, caffeine, nicotine, cannabis, and opioids) was assessed dichotomously (yes/no). Momentary symptoms, including fatigue, pain, stress, and depressive symptoms, were assessed using brief self-report measures. Mixed-effects logistic regression models assessed lagged associations between symptoms and subsequent substance use; multilevel models examined the reverse direction.
resultsMomentary increases in stress predicted lower odds of alcohol use. Higher average pain was linked to reduced alcohol use and increased opioid use. Substance use also predicted symptoms: alcohol, nicotine, and cannabis were associated with greater fatigue, whereas caffeine predicted reduced fatigue. Cannabis was linked to higher momentary pain, and opioids to higher average pain. Alcohol was associated with reduced stress, whereas caffeine predicted increased stress.
conclusionsMS symptoms and psychoactive substance use are dynamically and bidirectionally related. These findings improve understanding of how individuals with MS use substances for symptom regulation, which may lead to both beneficial and adverse outcomes.
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