PTOTSLPCohortArchives 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.

Jeeyeon Kim, Dawn M Ehde, Kevin N Alschuler and 2 others

PMID 41633444

WHAT IT FOUND

In adults with MS, alcohol use lowered stress but increased fatigue.

Caffeine reduced fatigue yet raised stress. Nicotine and cannabis increased fatigue. Opioid use was linked to higher average pain. Symptoms did not predict caffeine, nicotine, or cannabis use, suggesting habitual rather than reactive consumption.

Key findings

01Alcohol use was associated with lower stress at the next assessment but increased fatigue, while higher average pain predicted increased opioid use.

02Caffeine use reduced fatigue but increased stress; nicotine and cannabis use increased fatigue.

03No symptoms predicted the use of caffeine, nicotine, or cannabis, indicating these substances were likely consumed habitually rather than in response to momentary symptom spikes.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs

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What it does not show

Most participants had relapsing-remitting MS and moderate symptom levels, limiting generalizability to progressive MS or those with severe symptoms. Substance use was self-reported without details on dosage, type, or route, and the study did not distinguish between prescribed and recreational opioid use. Causality cannot be inferred from these temporal associations. The exact timing of substance use relative to symptom reporting was not assessed, only that it occurred since the last prompt. Observed effects were small at the momentary level, though they may accumulate over time.

Declared interests

None declared.

The easy way to misread this

Do not interpret these associations as causal effects or recommendations for substance use. The study shows temporal links in a specific MS population, but it cannot prove that changing substance use will reliably improve or worsen symptoms in an individual patient.

Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →