Cognitive-behavior Therapy for MS-Related Chronic Pain

Inclusion Criteria: * a confirmed diagnosis of Multiple Sclerosis, * history of daily pain or discomfort (burning, tingling or other parenthesis) for a period of 3 months immediately prior to enrollment, * judgment of one of the study neurologists (AL or MK) that the pain reported by the patient is either directly \[e.g., pain associated with optic neuritis and neuralgias\] or indirectly related \[e.g., pain due to painful muscle contractures and spasms\] to MS and/or its treatment (persons with pain that is judged to be entirely coincident with MS \[e.g., idiopathic low back pain\] will not be included), * documentation of optimal pharmacological management of MS-related pain and confirmation of this judgment by one of the study neurologists, * continued use of appropriate pharmaceuticals for the management of MS and pain, and * continued refractory pain despite pharmaceutical intervention as described above (as determined by a pain intensity score 4 on a 0-10 numeric rating scale). Exclusion Criteria: * pending surgery or interventional anesthesiological procedures for pain, * currently psychotic or actively suicidal or homicidal, * current alcohol or substance abuse or dependence, * presence of other life threatening illnesses, * the presence of profound cognitive impairment rendering successful participation in CBT or ED impossible, * the presence of physical disabilities resulting in an inability to attend treatment sessions and/or inability to participate in telephone interventions (e.g., severe dysarthria), * prior or current psychological treatment for chronic pain, * two or more documented exacerbations of MS-related symptoms during the past year, and * current exacerbation of symptoms defined as sudden onset of symptoms within a 24 hour period. Participants experiencing an exacerbation will be included after a one-month period of appropriate treatment or three months after the onset of the exacerbation. The Exacerbation Questionnaire, also described below and developed by Dr. Mohr, one of our co-investigators, will be used to assess and monitor significant exacerbations of MS. The Multiple Sclerosis Functional Composite (MSFC) score described below will be used to determine these later two exclusion criteria.