Migraine Headaches And Pain With Neuropathic Characteristics: Comorbid Conditions In Patients With Multiple Sclerosis.
Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM), UMR-S975, Université Pierre et Marie Curie-Paris 6, Paris, France. Electronic address: . Pain
(Impact Factor: 5.21).
08/2013; 154(12). DOI: 10.1016/j.pain.2013.07.050
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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- "In a survey of 673 individuals, migraine was more common in participants with neuropathic pain and vice versa (Moisset et al., 2013). Comorbid migraine and neuropathic pain were also associated with more intense headache pain, more intense neuropathic pain, and greater disruption of normal activities (Moisset et al., 2013). We found that depression was associated with 1.58-fold increased odds of pain. "
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Comorbidities are common in multiple sclerosis (MS). The high prevalence of pain in MS is well-established but the influence of comorbidities on pain, specifically, pain-related interference in activity is not.
To examine the relationship between comorbidity and pain in MS.
We recruited 949 consecutive patients with definite MS from four Canadian centres. Participants completed the Health Utilities Index (HUI-Mark III) and a validated comorbidity questionnaire at 3 visits over 2 years. The HUI's pain scale was dichotomized into two groups: those with/without pain that disrupts normal activities. We used logistic regression to assess the association of pain with each comorbidity individually at baseline and over time.
The incidence of disruptive pain over two years was 31.1 per 100 persons. Fibromyalgia, rheumatoid arthritis, irritable bowel syndrome, migraine, chronic lung disease, depression, anxiety, hypertension, and hypercholesterolemia were associated with disruptive pain (p<0.006). Individual-level effects on the presence of worsening pain were seen for chronic obstructive pulmonary disease (odds ratio [OR]: 1.50 95% CI: 1.08-2.09), anxiety (OR: 1.49 95% CI: 1.07-2.08), and autoimmune thyroid disease (OR: 1.40 95% CI: 1.00-1.97).
Comorbidity is associated with pain in persons with MS. Closer examination of these associations may provide guidance for better management of this disabling symptom in MS.
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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.
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