Longitudinal prevalence and determinants of pain in multiple sclerosis: results from the German National Multiple Sclerosis Cohort study

Abstract

Pain is frequent in multiple sclerosis (MS) and includes different types, with neuropathic pain (NP) being most closely related to MS pathology. However, prevalence estimates vary largely, and causal relationships between pain and biopsychosocial factors in MS are largely unknown. Longitudinal studies might help to clarify the prevalence and determinants of pain in MS. To this end, we analyzed data from 410 patients with newly diagnosed clinically isolated syndrome or relapsing-remitting MS participating in the prospective multicenter German National MS Cohort Study (NationMS) at baseline and after 4 years. Pain was assessed by self-report using the PainDETECT Questionnaire. Neuropsychiatric assessment included tests for fatigue, depression, and cognition. In addition, sociodemographic and clinical data were obtained. Prevalence of pain of any type was 40% and 36% at baseline and after 4 years, respectively, whereas prevalence of NP was 2% and 5%. Pain of any type and NP were both strongly linked to fatigue, depression, and disability. This link was even stronger after 4 years than at baseline. Moreover, changes in pain, depression, and fatigue were highly correlated without any of these symptoms preceding the others. Taken together, pain of any type seems to be much more frequent than NP in early nonprogressive MS. Moreover, the close relationship between pain, fatigue, and depression in MS should be considered for treatment decisions and future research on a possible common pathophysiology.

Pain syndrome patterns and their characteristics in multiple sclerosis patients

“…This indicates that this pattern is typical for headaches. It should also be borne in mind that the patient could have more than 1 type of pain syndrome with different localization of pain, which corresponds to the data of other studies [3,9]. In our sample of patients, the most common combination was tension-type headache and ongoing extremity pain.…”

“…Éìîâ³ðíîþ ïðè÷èíîþ öüîãî º ð³çíà ìåòîäî-ëî´³ÿ äîñë³äaeåíü. Äàí³ ìåòà-àíàë³çó âñòàíîâèëè, ùî ïîøèðåí³ñòü áîëþ ñåðåä ïàö³ºíò³â ³ç ÐÑ ñêëàäຠáëèçüêî 63% [3,4]. Òàêà ïîøè-ðåí³ñòü áîëüîâèõ ñèíäðîì³â ñåðåä ïàö³ºíò³â ç ÐÑ º çíà÷íî âèùîþ, í³ae ó çàãàëüí³é ïîïó-ëÿö³¿ ³ ñâ³ä÷èòü ïðî ¿õ âçàºìîçâ'ÿçîê òà âàaeëèâó ðîëü ó ñòðóêòóð³ öüîãî çàõâîðþâàííÿ.…”

“…Öå ñâ³ä÷èòü ïðî òå, ùî öåé ïàòåðí º õàðàêòåðíèì äëÿ ãîëîâíîãî áîëþ. Ñë³ä òàêîae âðàõîâóâàòè, ùî ïàö³ºíò îäíî÷àñíî ì³ã ìàòè ïîíàä 1 òèï áîëüîâîãî ñèíäðîìó ç ð³çíîþ ëî-êàë³çàö³ºþ áîëþ, ùî â³äïîâ³äຠäàíèì ³íøèõ äîñë³äaeåíü [3,9]. Ó íàø³é âèá³ðö³ ïàö³ºíò³â, íàé÷àñò³øèì ïîºäíàííÿì áóëè ãîëîâíèé á³ëü íàïðóãè ³ ïîñò³éíèé á³ëü ó ê³íö³âêàõ.…”

“…The probable reason for this is a different research methodology. Meta-analysis data found that the prevalence of pain among patients with MS is about 63% [3,4]. This prevalence of pain among MS patients is much higher than in the general population and indicates their relationship and important role in the structure of the disease.…”

Характеристики Качества Жизни Больных Рассеянным Склерозом В Зависимости От Типа Болевого Синдрома

“…При РС виникають різні види і типи болю та їх поєднання. Класифікації переважно поділяють больові синдроми при РС на нейропатичні, тобто ті, що виникають на основі структурних змін внаслідок РС, та інші типи болю, включаючи ноцицептивний, з менш вивченим причинно-наслідковим зв'язком виникнення болю [4].…”