Pain associated with multiple sclerosis: Systematic review and proposed classification

Abstract

Pain is common in patients with multiple sclerosis (MS), but estimates of its prevalence have varied widely. The literature describing pain in MS patients spans four decades and has employed a range of different methodologies. We undertook a systematic review in order to summarize current understanding of the association between MS and pain and provide a basis for the design and interpretation of future studies. The point prevalence of pain in patients with MS is nearly 50%, and approximately 75% of patients report having had pain within one month of assessment. Pain adversely affects most aspects of health-related quality of life, including functional domains such as the ability to work. The presence of pain in patients with MS is associated with increased age, duration of illness, depression, degree of functional impairment, and fatigue. Several different types of pain are found in patients with MS, including extremity pain, trigeminal neuralgia, Lhermitte's sign, painful tonic spasms, back pain, and headache. Putative mechanisms of pain in patients with MS are discussed, and a classification of pain in MS is proposed. Few randomized clinical trials of treatments for MS pain have been conducted, and the limitations of current knowledge regarding approaches for treating MS pain are discussed. Suggestions for future studies that would increase understanding of the natural history, mechanisms, and treatment of pain in patients with MS are presented.

Central Pain in Patients with Multiple sclerosis

“…This is consistent with published data reporting the prevalence range TN in multiple sclerosis from 1.6% to 18% [3,8,19,11,24]. The age of onset of multiple sclerosis-associated TN in patients has been noted to be about 10 years younger than in patients without multiple sclerosis [25][26][27].…”

“…Trigeminal neuralgia: After revision all our patients with TN confirmed criteria according Cruccu et al Our results showed TN to be present in 5.91% of multiple sclerosis patients, which is much higher than in general population (from 0.1% to 0.7%) [24]. This is consistent with published data reporting the prevalence range TN in multiple sclerosis from 1.6% to 18% [3,8,19,11,24].…”

Oral Palmitoylethanolamide Treatment Is Associated with Reduced Cutaneous Adverse Effects of Interferon-β1a and Circulating Proinflammatory Cytokines in Relapsing–Remitting Multiple Sclerosis

“…Pain is an important component of MS, which, despite its significant impact on patients' QoL, is often neglected or undertreated. Patients with MS present not only spontaneous pain, but also several forms of evoked pain such as cutaneous mechanical pain and cold hypersensitivity at the distal extremities [41,42]. Promising results in the treatment of pain have been reported for PEA in various clinical trials.…”

Interdisciplinary Treatment of Patients with Multiple Sclerosis and Chronic Pain

“…According to a 2004 study by Solaro et al, 1 studies usually classify pain symptoms according to temporal criteria rather than the World Health Organization pain treatment guidelines. 2 The physical pain described by people with MS is often widespread, chronic, and debilitating. The types of physical pain associated with MS can vary depending on the area of the brain affected.…”

“…The types of physical pain associated with MS can vary depending on the area of the brain affected. In 2008, O'Connor et al 2 proposed four classifications of MS-related pain: 1) continuous central neuropathic pain, 2) intermittent central neuropathic pain, 3) musculoskeletal pain, and 4) mixed neuropathic and non-neuropathic pain. Central neuropathic pain, which is pain experienced in the absence of any psychiatric disorder or peripheral neuropathic pain, is consistent with a CNS lesion and may affect between 27.5% and 58% of MS patients.…”