Pain in Multiple Sclerosis: Understanding Pathophysiology, Diagnosis, and Management Through Clinical Vignettes

Abstract

Neuropathic pain and other pain syndromes occur in the vast majority of patients with multiple sclerosis at some time during their disease course. Pain can become chronic and paroxysmal. In this review, we will utilize clinical vignettes to describe various pain syndromes associated with multiple sclerosis and their pathophysiology. These syndromes vary from central neuropathic pain or Lhermitte's phenomenon associated with central nervous system lesions to trigeminal neuralgia and optic neuritis pain associated with nerve lesions. Muscular pain can also arise due to spasticity. In addition, we will discuss strategies utilized to help patients manage these symptoms.

Lower corticospinal excitability and greater fatigue among people with multiple sclerosis experiencing pain

“… 37 , 51 The literature shows that most persons with MS experience pain from multiple sources, both neuropathic and non-neuropathic. 5 , 8 , 49 Participants here may therefore have suffered predominantly from non-neuropathic pain, 37 , 51 had more pain-associated limb disuse, 52 or used more medications that target corticospinal excitability (e.g., voltage-gated sodium channel blocking anticonvulsants). 40 If future work replicates our findings, low corticospinal excitability could be a putative therapeutic target for pain neuromodulation.…”

“… 57 We likewise did not explore alternative pain sources like spasticity, musculoskeletal complications of MS, or disease treatments. 8 , 9 By not differentiating pain etiology, the VAS may have limited the characterization of pain pathophysiology.…”

Palliative Care for Patients With Multiple Sclerosis

“…Most MS patients experience acute and/or chronic pain during their disease process. Chronic pain is experienced by 50% to 75% of patients with MS 20,21 . Pain in MS comes in many forms.…”

“…Patients experience pain from damaged nerves, neuromuscular spasms or stiffness, a sudden sharp electrical buzzing sensation known as Lhermitte's sign, trigeminal neuralgia, optic neuritis, migraines, and tight banding sensations in the chest referred to as the “MS hug.” 22 Patients may experience 1 form of pain or a combination (ie, a pain syndrome). Pain in MS has been associated with depression, decreased quality of life, inability to work, and increased disability 20,21,23 . Standard over-the-counter and commonly prescribed pain medications are ineffective in treating MS pain.…”

Targeting N-type calcium channels in young-onset of some neurological diseases

“…In 2008, O’Connor and colleagues proposed a classification of pain in MS into four categories: continuous central neuropathic pain, trigeminal neuralgia, musculoskeletal pain, and mixed neuropathic and non-neuropathic pain (i.e., headache) ( O'Connor et al, 2008 ). The type of pain syndrome that occurs in MS is typically associated with the part of the nervous system that is involved ( Racke et al, 2021 ). Central neuropathic pain has been reported as the commonest pain syndrome in MS and is associated with a primary CNS injury of the thalamus, or the parietal cortex, in which the projection areas for the sensory tract are located, and it is usually secondary to the lesions in the spino-thalamo-cortical pathways ( Solaro and Uccelli, 2011 ).…”