Effectiveness of a Mindfulness-Based Intervention for Pain Management in Patients With Multiple Sclerosis (MPIMS).

The intensity of pain will be assessed using the Visual Analogue Scale (VAS). The VAS is a self-reported measure of pain intensity in which participants rate their current pain on an 11-point scale ranging from 0 (no pain) to 10 (worst possible pain). Higher scores indicate greater pain intensity.

The dimensions of pain will be assessed using the Short-Form McGill Pain Questionnaire (SF-MPQ). The SF-MPQ is a 15-item instrument that assesses the qualitative characteristics of pain through 11 sensory and 4 affective descriptors, each rated on a 4-point scale from 0 (none) to 3 (severe). Total score ranges from 0 to 45, with higher scores indicating greater pain intensity and more severe pain qualities.

The impact of pain on daily functioning will be assessed using the Pain Self-Efficacy Questionnaire (PSEQ). The PSEQ is a 10-item questionnaire designed to evaluate an individual's confidence in performing daily activities despite pain. Each item is rated on a 7-point Likert scale ranging from 0 (not at all confident) to 6 (completely confident), yielding a total score from 0 to 60, with higher scores indicating greater pain self-efficacy.

The presence of neuropathic pain will be assessed using the Douleur Neuropathique 4 (DN4) questionnaire. The DN4 is a 10-item questionnaire consisting of 7 interview items assessing symptoms characteristic of neuropathic pain and 3 clinical examination items evaluating hypoesthesia to touch, hypoesthesia to pinprick, and pain evoked by brushing. Each item is scored as 0 (absent) or 1 (present), yielding a total score ranging from 0 to 10. A total score of ≥4 is indicative of neuropathic pain.

The emotional and cognitive impact of pain will be assessed using the Pain Catastrophizing Scale (PCS). The PCS is a 13-item self-administered questionnaire that assesses pain catastrophizing by evaluating negative thoughts and emotional responses associated with pain. It comprises three subscales: rumination (4 items), magnification (3 items), and helplessness (6 items). Each item is rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (all the time), yielding a total score ranging from 0 to 52, with higher scores indicating greater levels of pain catastrophizing.

The severity of pain will be assessed using the Brief Pain Inventory-Short Form (BPI-SF). The BPI-SF is a self-report questionnaire that assesses pain severity, pain interference with daily activities, and pain characteristics. It consists of 9 items. Pain severity is assessed using four items rated on an 11-point numeric rating scale (0 = "no pain" to 10 = "pain as bad as you can imagine"), while pain interference is assessed using seven items rated from 0 ("does not interfere") to 10 ("completely interferes"). Higher scores indicate greater pain severity.

Physical function will be assessed using the PROMIS-29 Profile, a patient-reported outcome measure that evaluates physical, mental, and social health, including physical function and pain interference. The PROMIS-29 consists of 29 items distributed across eight domains. The first seven domains are scored using a 5-point Likert scale, with four items per domain. The eighth domain assesses pain intensity using a single item scored on an 11-point numeric rating scale (0-10). Raw scores for each domain can be converted into standardized T-scores (mean = 50, SD = 10), with higher scores indicating more of the construct being measured.

Fatigue will be assessed using the Modified Fatigue Impact Scale (MFIS), a patient-reported outcome measure that evaluates the impact of fatigue on physical, cognitive, and psychosocial functioning.The scale consists of 21 items, each rated on a 5-point Likert scale ranging from 0 (never) to 4 (almost always). The total score ranges from 0 to 84, with higher scores indicating greater fatigue.

Depressive symptoms will be assessed using the Patient Health Questionnaire-9 (PHQ-9), a self-administered questionnaire that assesses the presence and severity of depressive symptoms over the previous two weeks. The questionnaire consists of 9 items rated on a 4-point Likert scale, ranging from 0 (not at all) to 3 (nearly every day). The total score ranges from 0 to 27, with higher scores indicating greater severity of depressive symptoms.

Anxiety will be assessed using the Generalized Anxiety Disorder-7 (GAD-7), which assesses the severity of anxiety symptoms. It consists of seven items rated on a 4-point Likert scale (0 = "not at all" to 3 = "nearly every day"). Total scores range from 0 to 21, with higher scores indicating greater anxiety severity. Scores of 0-4 indicate minimal anxiety, 5-9 mild anxiety, 10-14 moderate anxiety, and 15-21 severe anxiety.

Sleep disturbance will be assessed using the PROMIS Sleep Disturbance Short Form 6a (PROMIS-SD SF 6a). The PROMIS-SD SF 6a assesses the individual's subjective perception of sleep quality, sleep depth, and sleep restoration over the previous 7 days. It consists of six items rated on a 5-point Likert scale (1 = "very poor" to 5 = "very good"). Raw scores range from 6 to 30 and are converted into standardized T-scores (mean = 50, SD = 10). Higher T-scores indicate greater sleep disturbance (i.e., poorer sleep quality), whereas lower T-scores indicate better sleep quality.

Quality of life will be assessed using the Multiple Sclerosis International Quality of Life Questionnaire (MusiQoL), which assesses health-related quality of life across nine domains in people with multiple sclerosis. It consists of 31 items and item is rated on a 5-point Likert scale (0 = "never" to 5 = "always"). Raw scores for each dimension and the overall score are transformed to a standardized scale ranging from 0 to 100, with higher scores indicating better health-related quality of life.

Mindfulness will be assessed using the Mindful Attention Awareness Scale (MAAS) The MAAS is a self-report questionnaire that assesses the frequency with which individuals experience lapses in attention and awareness of the present moment. It consists of 15 items rated on a 6-point Likert scale (1 = "almost always" to 6 = "almost never"). The overall score is calculated as the mean of the 15 items, ranging from 1 to 6. Higher scores indicate greater dispositional mindfulness.

Sleep quality will be assessed using the Pittsburgh Sleep Quality Index (PSQI). The PSQI is a self-administered questionnaire that assesses sleep quality and sleep patterns over the previous month. It consists of 19 self-rated items grouped into seven components. Each component is scored from 0 to 3 (0 = no difficulty, 3 = severe difficulty), yielding a global score ranging from 0 to 21. Higher scores indicate poorer sleep quality.

Dispositional mindfulness will be assessed using the Five Facet Mindfulness Questionnaire (FFMQ). The FFMQ is a self-report instrument and it consists of 39 items distributed across five dimensions: observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience. Items are rated on a 5-point Likert scale ranging from 1 ("never or very rarely true") to 5 ("very often or always true"). Total scores range from 39 to 195, with higher scores indicating greater mindfulness.