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2012, Neurological Research
About 65% of multiple sclerosis (MS) patients experience a broad range of both acute and subacute painful syndromes.Acute conditions (eg, trigeminal neuralgia and Lhermitte's syndrome) cause intense, unrelenting pain that may worsen with age and disease progression. Chronic pain (eg, joint pain) is also a component of MS. Pain syndromes, including optic neuritis, complex regional pain syndrome [CRPS], and other less well-known syndromes, may respond to a variety of pharmacologic, surgical, or alternative interventions. MS patients may also experience iatrogenic pain. Some successful drug treatments for pain that are used in combination or alone include anticonvulsants, tricyclics, antidepressants, methylprednisolone, and narcotics. Surgical interventions, percutaneous compression-balloons, and radiofrequency ablation are other viable options for some pain syndromes. (Int J MS Care. 2000;2(3):30-34.) Dr. Kassirer is an Assistant Professor of Neurology at The International Journal of MS Care Editorial Board and Staff look forward to serving the needs of the MS community in the months to come.
Pain, 2008
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. Ó
Rad Hrvatske Akademije Znanosti I Umjetnosti Medicinske Znanosti, 2009
Multiple sclerosis (MS) is a disease of the central nervous system (CNS), beginning most often in late adolescence and early adult life and expressing itself by reccurrent attacks of spinal cord, brainstem, cerebellar, optic nerve and cerebral dysfunction, the result of foci of destrucion of myelinated fibers. Neuropathic pain, such as trigeminal neuralgia might be one of the first symptoms of multiple sclerosis. In this retrospective study we evaluated 290 patients who have been hospitalised at Department of neurology in last three years. According to the results of our study 70% had either an acute or chronic pain syndrome at some time during their disease. Between them 2.7% with acute pain syndroms had episodes of paroxismal pain attacks in distribution of trigeminal nerve. Chronic pain syndromes, occured in 58% of patients and included headache (25%), low back pain (35%) and painful leg spasms in 20% of patients. Our patients were treated with nesteroid antireumatic drugs in case of nociceptive pain, but neuropathic pain was treated with combination of antidepressive and antiepileptic drugs.
American Journal of Internal Medicine, 2014
The pathophysiology of pain in multiple sclerosis (MS) is poorly understood, but there are multiple schools of thought. Different mechanisms are associated with causation of this pain e.g. acute pain due to inflammation; chronic or intermittent neuropathic pain related to central nervous system (CNS) lesions; pain secondary to spasticity, spasms and muscle cramps from higher motor neuron lesions; and musculoskeletal pain from adopting maladaptive body positions and general physical deconditioning. Similarly evidence for treating pain in MS is limited. Treatment is often based on anecdotal reports and clinical experience as there is scarcity of randomized placebo-controlled trials for evidence of pharmacological treatment of pain in MS. The aim of this article is to provide a brief review of current concepts about the nature, causes and management of pain in MS.
Neurologia i Neurochirurgia Polska, 2014
Archives of Neurology, 2003
Background: Pain is an important symptom in patients with multiple sclerosis (MS). The estimated pain prevalence varies between 30% and 90%. To our knowledge, previous studies do not include a whole population sample of patients with MS. Objective: To assess pain prevalence and its clinical characteristics and impact on daily life in a population sample of MS patients and in a reference group.
Acta Scientific Medical Sciences, 2020
Multiple sclerosis (MS) is an autoimmune disorder characterized by immune cell infiltration and inflammation within the central nervous system (CNS). Relapsing-remitting MS and secondary progressive MS cause progressive demyelination and neurodegeneration [1]. Today we know the autoimmune origin of the disease, especially the involvement of auto-aggressive T cells directed against neuronal myelin [2]. Women are affected twice as often as men. The mean age of MS onset is 30 years of age; women generally fall ill earlier than men [3]. It is characterized by a large spectrum of symptoms and signs, involving several functional systems (pyramidal, cerebellar, sensory, brainstem, bowel and bladder, visual, mental, and ambulation) [4]. It is well known that neuropathic pain has a negative impact on MS patients' quality of life. Neuropathic pain is most directly related to the pathology of MS and its prevalence has been estimated to be 29% in a meta-analysis [5]. Previous studies on the prevalence of neuropathic pain in the early stages of MS found a point prevalence of 14% and a lifetime prevalence of 28% [6].
NeuroRehabilitation, 2019
The aim of this commentary is to discuss the rehabilitation perspective in the recently published Cochrane Review "Non-pharmacological interventions for chronic pain in multiple sclerosis" by Amatya, Young & Khan. 1 , under the direct supervision of Multiple Sclerosis and Rare Diseases of the CNS group. This Cochrane Corner is produced in agreement with NeuroRehabilitation by Cochrane Rehabilitation.
Multiple Sclerosis and Related Disorders, 2019
Background: Although there is accumulating evidence on neuropathic pain in persons with multiple sclerosis (pwMS), little is known about musculoskeletal pain. The aim was to examine the frequency, type, distribution of pain and related factors in pwMS. Methods: This cross-sectional study included 223 pwMS. The Nordic Musculoskeletal Questionnaire and painDETECT Questionnaire were used to assess pain. Depression, fatigue, sleepiness, and health-related quality of life were assessed. Results: 23.3% of participants did not have pain, 55.6% had musculoskeletal pain and 21.1% had neuropathic pain. There was no significant difference between the groups in age, gender, disease duration, employment status, marital status and education level (p > .05). The participants without pain had lower Expanded Disability Status Scale (EDSS) scores compared to those with neuropathic pain (p = .024). In addition, the participants with musculoskeletal pain had lower EDSS scores compared to those with neuropathic pain (p = .027). Depression, fatigue, sleepiness and quality of life scores were significantly different between the groups (p < .05). Participants with neuropathic pain had significantly lower quality of life, and higher fatigue, depression and sleepiness compared to participants with musculoskeletal pain and without pain (p < .05). Musculoskeletal pain was most common in low back (52.4%), neck (51.6%), and upper back (45.2%). Conclusions: This study suggests that pain is a very common symptom among pwMS. Pain frequency is high as 76.7%. In particular, the presence of neuropathic pain is associated with lower health-related quality of life and higher levels of depression, fatigue and sleepiness. Musculoskeletal pain was most common in the spine area including neck, upper back, and low back.
Internal Medicine and Care
Objective: To identify pain prevalence, severity, frequency, duration, quality, location, distribution, type, and treatment in a large, well-designed sample of community dwelling individuals with multiple sclerosis (MS). Methods: This was a cross-sectional study. A centre-stratified random sample including 188 persons with MS were recruited from three major MS clinics in the Greater Montreal region, Canada. Main outcomes included pain prevalence, severity, frequency, duration, quality, location, distribution, type, and treatment. Results: 42% identified pain as a symptom, and among those, 60% reported severe pain. Pain differed among participants in severity, type, location, duration, frequency, and quality. Additionally, the average of total percent of body surface that participants had shaded as painful was 20%. Leg pain was the most common anatomical site of pain followed by arm pain and back pain. Neuropathic pain was the most commonly reported type of pain. The majority of participants used pharmacological techniques for pain relief. The pain management techniques were used mainly by women, participants with more disability, severe pain, younger participants, and also those who were employed. Conclusion: Pain is a common symptom in MS. The considerable severity and distribution of pain on individuals with MS confirm the importance of accurate assessment and adequate intervention approach for pain treatment in people with MS.
2015
Background: Pain, a common phenomenon in multiple sclerosis (MS) patients, is associated with many symptoms and problems. Aim: To investigation severity and distribution of musculoskeletal pain in MS patients. Methods: In this cross-sectional study, 115 members of the Mazandaran MS Association with confirmed MS were randomly selected to participate in the study. The patients were asked to fill out Numerical Rating Score and Nodric questionnaires, respectively. The data was analyzed by SPSS ver. 16 software. Results: The mean age of the participants was 30.43±5.86 years and 88 cases (76.5%) were female. The mean disease duration was 26.34±24.32 months and 87.8% of the cases were experiencing pain at the time of study. The mean pain severity was 3.75±2.25 and worst pain experienced was 5.73±2.12. The most common pain sites were: the knees (55.7%), wrist (43.5%), and neck (41.7%). Women experience higher prevalence of shoulder, upper back, and ankle pain (P<0.05). In 62 cases (53.91...
Multiple Sclerosis, 2008
Neurología (English Edition), 2011
Introduction: Despite pain being a disabling symptom in patients with multiple sclerosis (MS), its prevalence and characteristics are not well established. the aim of this study is to describe the characteristics and prevalence of pain in patients with MS, and to assess the associated clinical variables and radiological findings. Methods: We prospectively studied patients with MS. A structured questionnaire which evaluated depression symptoms, type of pain, location, intensity (defined according to a visual analogue scale (VAS) as severe (VAS 7-10), moderate (VAS 4-6) and mild (VAS 0-4), and pain therapy was recorded in patients who referred to pain at the time of interview. Protocol variables were demographic data, MS clinical forms (remitting-relapsing, progressive-secondary and progressive-primary), neurological dysfunction (defined according to EDSS scale), symptoms at onset, attack frequency, illness duration, disease modifying treatment, fatigue, spasticity, oligoclonal bands in cSF, visual evoked potentials, depression symptoms (Hamilton test) and presence of lesions in spinal cord MRI. Results: A total of 134 MS patients were included, and MRI was performed on 105 of them. Pain was reported by 74 (55%) patients and was most frequently neuropathic, located in limbs, severe and burning/spiky. Of these 28 (38%) received therapy for their pain, based predominantly in anti-inflammatory drugs. Patients with pain had a worse functional state (EDSS score, 4.5 [3-6] vs 1.5 [1-2], p<0.001), higher number of relapses (7.13±3.4 vs 3.75±2.9, p<0.001), progressive forms of MS (86.7% vs 13.3%, p<0.001), depression (91.9% vs 8.1%, p<0.001), spinal cord involvement at onset (79.2% vs 20.8%, p=0.009), spinal cord lesions by MRI (84.3% vs 15.7%, p<0.001) and longer duration of disease (14.6±7.8 vs 8.43±5.9 months, p<0.001). In a logistic regression model, the presence of lesions in spinal cord MRI (OR 3.5 [1.5-24.5]) and higher EDSS score (OR 1.7 [1.1-2.7]) were independently associated with pain. Conclusions: Pain is a frequent disabling symptom in MS and is associated with disability and spinal cord lesions.
Acta clinica Croatica, 2014
In the study, we evaluated 61 multiple sclerosis patients hospitalized at our hospital in the period from October 1, 2013 to February 15, 2014. The aim of the study was to investigate pain syndromes associated with the underlying disease. Pain in the month preceding assessment was reported by 90% of patients. Most patients suffered from low back pain (52%) and musculoskeletal pain (39%), followed by neck pain (31%), painful tonic spasm (26%), neuropathic extremity pain (23%) and pain due to spasticity (21%). Other types of pain were present in less than 20% of patients. A total of 67% of patients were taking analgesics; the most frequently used were nonsteroidal antiinflammatory drugs, while drugs against neuropathic pain were taken by a smaller number of patients. The high incidence of pain syndromes pointed to the importance of regular physical therapy procedures.
Current Clinical Pharmacology, 2007
Pain is a frequent and disabling symptom among multiple sclerosis (MS) and it is estimated to occur in 55% to 65% of patients. The mechanism of pain in MS has not yet been defined, because it can result from somatic, visceral, emotional, or neurologic impairment. The importance of this classification is related to different medical approaches to treat the pain in MS patients. In the management of symptomatic pain, new therapeutic strategies are now available to represent a great opportunity improving the quality of life. The availability of newer drugs for symptomatic treatment of pain in MS indicates a need to pay attention to this problem.
The Journal of Pain, 2001
This study investigated the pain management techniques used by patients with multiple sclerosis. Participants from a state branch of the National Multiple Sclerosis Society completed surveys asking for their "most" and "least" effective pain management techniques. Participants then rated these techniques as to their effectiveness. Ninety percent of participants reported pain, with usual pain being in the moderate range. Typical respondents reported several effective and ineffective pain management strategies including medication, physical manipulation, exercise, psychosocial or alternative techniques, and rest/sleep. The health care and quality of life of patients with multiple sclerosis might be significantly improved if these pain experiences and strategies were to receive more clinical and research attention.
European Journal of Neurology, 2004
Pain is a frequent and disabling symptom among multiple sclerosis (MS) patients. The importance of this problem was investigated in a hospital based MS population.A total of 142 MS patients underwent neurological examination and a structured interview for registration of pain and sensory symptoms.One‐hundred and five patients reported sensory and/or pain symptoms. Pain was reported by 93 patients and was most frequently located in the limbs and lumbar region. The presence of pain was independent of gender, age at onset and examination, disability, disease course and duration. The most frequently reported characteristics of the symptoms were paresthesia, neuralgia and deep muscular aching. About 40% of the patients reported that the symptoms had important influence on daily activities. Only one‐third of the patients were treated for their pain.Pain is a frequent and disabling symptom, independent of demographic and clinical variables in MS patients. The low frequency of treatment for...
In a multicenter cross-sectional study, the authors assessed pain in patients with multiple sclerosis (MS) using a symptom-oriented approach. Out of 2,077 questionnaires, we used 1,672 for data analysis. Pain and frequencies included trigeminal neuralgia 2%, Lhermitte's sign 9%, dysesthetic pain 18.1%, back pain 16.4%, and painful tonic spasms 11%. Comparison between different groups showed significant differences for age, Expanded Disability Status Scale, disease duration, and disease course, but not for sex. This study underlines the relevance of pain in the clinical history of MS.
Expert Opinion on Pharmacotherapy, 2011
Pain, dysphagia, respiratory problems, sexual and cardiovascular dysfunctions may occur in patients with multiple sclerosis (MS).
Guide to the Inpatient Pain Consult, 2020
Multiple sclerosis (MS), an immune-mediated demyelinating disease of the central nervous system (CNS), is one of the leading causes of debility in adults. The prevalence of MS varies from 100 per 100,000 in North America and Europe to 2 per 100,000 in Eastern Asia and sub-Saharan Africa populations [1] primarily affecting middle aged (20-50 years old) women at a 3:1 female to male ratio [2]. A range of neurological and musculoskeletal symptoms may occur in patients with MS including cognitive dysfunction, gait impairments, depression, spasticity, fatigue, pain, and visual disturbances. Pain has been shown to have variable rates of prevalence in patients with MS. A systematic literature review by Foley et al. and O'Conner et al., found up to 63% and 50% of patients with MS experienced a form of pain, respectively [3, 4]. The most common acute manifestations of pain in this population include headaches, back pain, and arthralgias [5]. Foley et al. studied the prevalence of symptoms in MS patients. Forty-three percent of patients experienced headaches, 26%
Clinical Neurology and Neurosurgery, 2013
Objective: Drug-resistant trigeminal neuralgia (TN) can complicate the clinical course of patients affected by multiple sclerosis (MS). Various surgical procedures have been reported for the treatment of this condition, but there is no agreement on the best management of these patients. To our knowledge, there is no critical literature analysis focusing on this particular topic. The aim of this study was to evaluate the clinical outcome of different surgical procedures utilized for drug-resistant TN in MS patients. Methods: We reviewed the literature about the studies reporting on surgical treatment of drug-resistant TN in MS patients. Case reports and case series less than 4 patients were excluded from the analysis. Nineteen studies were selected for the statistical analysis. To reduce the variability of the data, the selected studies were evaluated for the following outcome parameters: acute pain relief rate (APR), rate of recurrence (RR), pain free at follow-up rate (PF at FU) and complication rate (CR). For the statistical analysis, chi-square statistic, using the Fisher's exact test was utilized. Results: There was no procedure statistically superior in terms of APR rate in MS patients following the surgical treatment of TN. The highest RR was observed for percutaneous balloon compression (PBC) (60.2 ± 14.4%). This result was statistically significant when compared to gamma knife surgery (GKS) (p = 0.0129) and microvascular decompression (MVD) (p = 0.0281). MVD together with percutaneous radiofrequency rhizothomy (PRR) was associated with a statistically better PF at FU rate (56.5 ± 16.8% and 73.5 ± 14.2%, respectively). However PBC and MVD showed statistical significant minor CR compared to other techniques (no complications and 18.7 ± 17.4%, respectively). Conclusion: Our study shows no differences in the short term results among different procedures for TN in MS patients. Each technique demonstrate advantages and limits in terms of long term pain, recurrence rate and complication rate. Each patient should be accurately informed on pros and cons of each procedure in order to be involved in the most appropriate choice.
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