Pain associated with multiple sclerosis: Systematic review and proposed classification

Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA.
Pain (Impact Factor: 5.21). 08/2008; 137(1):96-111. DOI: 10.1016/j.pain.2007.08.024
Source: PubMed


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.

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Available from: John Markman, Jan 06, 2015
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    • "Recently, special attention has been paid on the diagnosis and management of these symptoms. Painful syndromes encountered in MS patients have been well described and divided in four major categories: trigeminal neuralgia , spasticity, neuropathic and musculoskeletal pain syndromes [12]. In addition, depression and anxiety usually associated with chronic health problems have been investigated over the last few years. "
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    • "Further subdivision into nine categories has been suggested based upon the proposed underpinning mechanisms (Truini et al. 2013). Herein, we have reviewed research on the most common MS-related neuropathic pain conditions including ongoing pain in the extremities (dysaesthetic extremity pain), as well as paroxysmal pain (trigeminal neuralgia and L’hermitte’s phenomenon) (O’Connor et al. 2008; Truini et al. 2013). "
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    • "For example, injection of a TH1 cell population producing pro-inflammatory cytokines increased the level of neuropathic pain, whereas injection of a TH2 cell population producing anti-inflammatory cytokines attenuated pain sensitivity in nerve-injured rats (15). As chronic neuropathic pain affects the majority of MS patients (10, 17), it is believed that modulation of pro-inflammatory T cells and their associated cytokine response will mitigate such symptoms. "
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