Central pain; Nociceptive pain; Health-related quality of lifePain in MS stemming from the disease itself includes acute pain syndrome (trigeminal neuralgia, Lhermitte's sign, painful tonic seizures, segmental burning dysaesthesia, neuralgia, migraine) or chronic pain syndrome (chronic dysesthetic pain, painful leg spasms, and optic Abstract Introduction: Pain is a key symptom in patients with multiple sclerosis (MS), but the prevalence of pain in MS and its impact on quality of life of the patients is still underestimated.Objective: The aim of the study was to examine the occurrence of pain in MS patients, to identify the pain conditions and the relationship to important demographic variables (age, gender, type of MS) and to determine its impact on quality of life.Methods: Questionnaires on pain and health-related quality of life were sent to 307 patients with definitive MS diagnose. All patients with painful sensations were examined with aim to diagnose central and peripheral neuropathic and nociceptive pain. Results:Out of 220 responders 92% reported at least one type of pain or unpleasant pain sensation. Pain was more frequent in relapsing-remitting form of MS than in secondary progressive MS (p<0.0001) and less frequent in males than females (p=0,001). The ratio of different pain types was as follows: 51.38% headache, 57.94% neck or low back pain, 40.91% central neuropathic extremity and trunk pain, 5.91% trigeminal neuralgia, 34.26% Lhermitte's sign, 2.47% peripheral neuropathic pain. The commonest location of pain was lower extremities (84.09%) and the commonest pain quality was painful stiffness. Two and more concurrent pain locations were reported by 87.2% of patients and the total number of pain locations significantly increases with disease duration (p<0.0001). Pain limited the activities of daily living in 61.5% of patients. Conclusion:Our study confirmed the heterogenity of pain experienced in MS, the capacity to experience more than one type of pain simultaneously and inadequate pain treatment. Therefore pain is an important therapeutic target in MS.

Central pain (CP) is little recognized and diagnosed type of pain in multiple sclerosis.Objective: This second part of our work related to pain in multiple sclerosis is concentrated on occurrence of CP and defined its characteristics.Methods: Questionnaires on pain were sent to 307 patients with definitive multiple sclerosis diagnose. Patients admitting to CP were examined with aim to diagnose CP. The dates were statistically processed.Results: Out of 220 responders 92% reported pain during the course of their multiple sclerosis. CP was found in 57.72%, including 40.91% with central neuropathic extremity and trunk pain (CNEP), 5.91% with trigeminal neuralgia (TN), and 33.18% with Lhermitte's sign (LS). In 28.8% of all patients, CP was an initial multiple sclerosis symptom. The prevalence of CP does not increase with age, disease duration, or the Expanded Disability Status Scale (EDSS). Lower extremities were the commonest location of CNEP (74.5%) and burning was the commonest painful sensation. Three and more concurrent unpleasant painful sensations experienced 68.9% of patients, which were in 46.7% located in the lower extremities. Three and more concurrent CP locations (including TN and LS) were reported by 89% of patients. Number of locations in CP increases significantly with age and EDSS, in contrast to group with nociceptive and peripheral neuropathic pain (n=113), where does not increase with age, EDSS and multiple sclerosis duration. The group with nociceptive and peripheral neuropathic pain featured significantly less patients with only one pain location (p=0.0269) and only one pain quality. In contrast to the other group, In CP increases significantly the number of patients with increase the number of concurrent pain qualities (p<0.0001). Conclusion:CP is not only a frequent complaint among persons with multiple sclerosis, but is a distinctive type of pain requiring special attention and their identification remains still the major challenge.