Migraine Headaches And Pain With Neuropathic Characteristics: Comorbid Conditions In Patients With Multiple Sclerosis.
ABSTRACT We conducted a postal survey to assess the prevalence and characteristics of neuropathic pain and migraine in a cohort of multiple sclerosis (MS) patients. Of the 1300 sent questionnaires, 673 could be used for statistical analysis. Among respondents, the overall pain prevalence in the previous month was 79%, with 51% suffering pain with neuropathic characteristics (NC) and 46% migraine. MS patients with both migraine and NC pain (32% of the respondents) reported more severe pain and had lower health-related quality of life than MS patients with either migraine or NC pain. Pain intensity in MS patients with migraine was moderate (6.0±0.1). Migraine was mostly episodic but headaches were occurring on 15 or more days per month in 15% of these migraine sufferers. MS patients with migraine were younger and had shorter disease durations than those with NC pain. NC pain was most often located in the extremities, back and head, and was frequently described as tingling and pins-and-needles. The intensity of NC pain was low to moderate (4.9±0.1), but positively correlated with the number of painful body sites. Nonetheless, patients with NC pain were more disabled (with a higher EDSS and pain interference index) than migraineurs. Migraine, but not NC pain, was associated with age, disease duration, relapsing-remitting course and beta interferon treatment. This suggests that NC pain and migraine are mediated by different mechanisms. Therefore, pain mechanisms that specifically operate in MS patients need to be characterized to design optimal treatments for these individuals.
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ABSTRACT: Objective Pain is a common symptom of Multiple Sclerosis (MS). Biomedical treatments achieve only modest reductions in pain severity suggesting this approach may be too narrow. The aim of this systematic review was to assess evidence for associations between modifiable psychosocial factors and MS pain severity and pain interference and use this evidence to develop a preliminary biopsychosocial model of MS pain. Methods Empirical studies of pain in MS utilising standardised pain severity and pain interference measures were included. Online databases (Cochrane, PsychInfo, EMBASE, CINAHL, Medline, Web of Science and World Cat) and reference sections of included articles were searched, and corresponding authors contacted to identify unpublished studies. Information about design, sample size, MS type, time since diagnosis, psychosocial and pain measures and key findings were extracted. Thirty-one studies were assessed for quality and a narrative synthesis was conducted. Results Similar to primary chronic pain, most studies reported small to medium associations between several psychosocial factors and pain severity and interference. Pain catastrophizing showed consistently strong associations with pain interference. Preliminary findings revealed a strong correlation between pain acceptance and pain interference. However, fear- avoidance appeared less important in MS, and other forms of behavioural avoidance were not explored. Conclusions A preliminary model of MS pain outlining specific psychosocial factors is presented with a conceptual formulation from both traditional, and contextual, cognitive-behavioural perspectives. Pain catastrophizing, acceptance, and endurance, as opposed to fear avoidance, responses are highlighted as potentially important treatment targets in MS, and directions for future research are outlined.Journal of Psychosomatic Research 07/2014; 78(1). DOI:10.1016/j.jpsychores.2014.07.008 · 2.84 Impact Factor
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ABSTRACT: Established in 2003, the multiple sclerosis (MS) regional hospital network in the Auvergne area of France links not only neurologists but also many other specialists (e.g., urologists, ophthalmologists) and more than 400 other allied healthcare professionals (including physiotherapists, nurses, occupational therapists) involved in the care of patients with MS. This multidisciplinary network aims to improve quality of care for an estimated 1600 + MS patients in the Auvergne region through numerous training courses and medical support programs. The initiative is supported by the regional regulatory authority and receives public funding from the Auvergne regional state health insurance office. The Auvergne MS network has facilitated improvements in quality of care by coordinating patient care in the proximal vicinity of the patient's home and has provided useful information about MS epidemiology (incidence and prevalence) in the region. Using a multidisciplinary approach, the Auvergne MS network has explored other avenues of domiciliary-based care to seek improvements in the patient-centered management of MS. These include: access to high-dose methylprednisolone in the home, ensuring appropriate supervision and support; participation in national clinical research programs coordinated from hospital centers of excellence; provision of multidisciplinary clinic services where healthcare professionals across different disciplines can attend to the patient on the same day in the same center of care; development of individual and group-based cognitive therapy programs; educational programs focusing on the management of fatigue and cognitive impairment associated with MS; and educational programs focusing on optimal use of immunomodulating agents in MS patients.Expert Review of Neurotherapeutics 12/2013; 13(12 Suppl):39-44. DOI:10.1586/14737175.2013.865873 · 2.83 Impact Factor