Pain in multiple sclerosis: A systematic review of neuroimaging studies

Abstract

IntroductionWhile pain in multiple sclerosis (MS) is common, in many cases the precise mechanisms are unclear. Neuroimaging studies could have a valuable role in investigating the aetiology of pain syndromes. The aim of this review was to synthesise and appraise the current literature on neuroimaging studies of pain syndromes in MS.MethodsWe systematically searched PubMed and Scopus from their inception dates to the 2nd of April 2013. Studies were selected by predefined inclusion and exclusion criteria. Methodological quality was appraised. Descriptive statistical analysis was conducted.ResultsWe identified 38 studies of variable methodology and quality. All studies but one used conventional structural magnetic resonance imaging, and the majority reported a positive association between location of demyelinating lesions and specific neuropathic pain syndromes. Most investigated headache and facial pain, with more common pain syndromes such as limb pain being relatively understudied. We identified a number of methodological concerns, which along with variable study design and reporting limit our ability to synthesise data. Higher quality studies were however less likely to report positive associations of lesion distribution to pain syndromes.ConclusionsFurther high quality hypothesis-driven neuroimaging studies of pain syndromes in MS are required to clarify pain mechanisms, particularly for the commonest pain syndromes.

MECHANISMS IN ENDOCRINOLOGY: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional magnetic resonance imaging studies

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Whole‐body reversible neuropathic pain associated with right parieto‐temporal operculum single inflammatory lesion in a patient with multiple sclerosis: A case report

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Cluster Headache as the Index Event in MS: A Case Report

“…MRI findings in MS patients with headache and head pain have been described in a systematic review by Seixas et al The most significant findings were the association of trigeminal neuralgia with trigeminal nerve lesions in the brainstem, and migraine with lesions in the midbrain, red nucleus, substantia nigra, and periaqueductual gray matter . In the case reports of patients with CH and MS, while multiple supratentorial lesions were present, 2 patients showed brachium pontis lesions ipsilateral to the CH attacks, and a third patient with CH and MS had a lesion in the superior cerebellar peduncle ipsilateral to the headache attacks .…”