Multiple sclerosis and pain

Abstract

Despite the common belief that multiple sclerosis (MS) is a painless disease, several studies contradict this. There are a significant number of MS patients who actually suffer from painful conditions such as central and peripheral neuropathy, migraines, trigeminal neuralgia, painful tonic spasms, complex regional pain syndrome, glossopharyngeal neuralgia, and transverse myelitis. In addition, MS relapses are usually painful with many patients complaining of paroxysmal dystonia and neuropathic pain during these episodes. Additionally, treatments for MS such as use of beta-interferons may be associated with headache and pain at the injection site. The pathophysiology of pain in MS is poorly understood, but may be related to the development of demyelinating lesions involving certain neuroanatomic pathways such as the spinothalamic tract. Management of pain in MS patients is a therapeutic challenge for clinicians. Currently, various pharmacological agents such as antiepielptics, non-steroidal anti-inflammatory agents, and even corticosteroids are used to suppress various painful conditions associated with MS. Non-pharmacological procedures such as massage therapy have also been used in the treatment of MS patients. The authors present a review of recent findings in pathophysiology and management of pain in MS patients.

Case Report: Scrambler Therapy for Treatment-Resistant Central Neuropathic Pain in a Patient with Transverse Myelitis

“…12 MRI studies support the hypothesis that central neuropathic pain triggered by MS is more common in those with myelopathic lesions. 12 As such, it is not surprising that the burden and prevalence of pain is even greater in patients with severe spinal cord damage from NMOSD, with 62-91% reporting its presence; research reveals that its pervasiveness impacts mood, mobility and quality of life. 4,5,13,14 Our patient experienced persistent central neuropathic pain for 3.5 years prior to…”

Chronic Pain in Multiple Sclerosis Patients: Utility of Sensory Quantitative Testing in Patients with Fibromyalgia Comorbidity

“…Hence, demyelinating disorders might alter the thermal and discomfort thresholds, thus predisposing patients to pain during the course of the disease [5,31]. The pathophysiology of pain in MS is poorly understood but could be related to the development of demyelinating lesions involving certain neuroanatomic pathways such as the spinothalamic tract [32]. So, the method adopted in our study, which selectively examines the sensory perception of the small fibers and the corresponding central pathways, may be useful in discovering the involvement of such circuit, even at the preclinical stage [5,33,34].…”

Central Neuropathic Pain Syndromes

“…[60][61][62] It is usually associated with an acute or subacute demyelinating plaque in the cervical spine and resolves over several weeks. 63 Magnetic resonance imaging (MRI) and electrophysiologic data have documented that Lhermitte sign is associated with the posterior column (touch, proprioception) and not nociceptive spinothalamic tract dysfunction. 23,61,64 This feature distinguishes Lhermitte sign from central neuropathic pain, in which spinothalamic tract sensory loss is invariable.…”