Unique features of central neuropathic pain in multiple sclerosis: Results of a cluster analysis

Rivel, Michal; Achiron, Anat; Dolev, Mark; Stern, Yael; Zeilig, Gabi; Defrin, Ruth

doi:10.1002/ejp.1934

Cited by 16 publications

(12 citation statements)

References 67 publications

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“…One patient (n° 57) with normal LEPs but delayed CEPs was under evaluation for multiple sclerosis due to abnormal CSF findings and T2 hyper‐intensities on spinal and brain MRIs. The isolated CEP abnormality of this patient was not considered as a ‘false positive’ since cold hypoesthesia has been suggested as a sign of MS‐related central pain (Rivel et al, 2022). Finally, 5 patients had different levels of altered sensory thresholds to cold, and 3 had cold‐specific symptoms, including cold‐heat transformation, which could be related to the CEP abnormalities.…”

Section: Resultsmentioning

confidence: 93%

Cold‐evoked potentials in clinical practice: A head‐to‐head contrast with laser‐evoked responses

Perchet

Hagiwara

Salameh

et al. 2023

European Journal of Pain

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BackgroundInnocuous cooling of the skin activates cold‐specific Aδ fibres, and hence, the recording of cold‐evoked potentials (CEPs) may improve the objective assessment of human thermo‐nociceptive function. While the feasibility of CEP recordings in healthy humans has been reported, their reliability and diagnostic use in clinical conditions have not been documented.MethodsHere, we report the results of CEP recordings in 60 consecutive patients with suspected neuropathic pain, compared with laser‐evoked potentials (LEPs) which are the gold standard for thermo‐algesic instrumental assessment.ResultsCEP recording was a well‐tolerated procedure, with only ~15 min of surplus in exam duration. The reproducibility and signal‐to‐noise ratio of CEPs were lower than those of LEPs, in particular for distal lower limbs (LLs). While laser responses were interpretable in all patients, CEPs interpretation was inconclusive in 5/60 because of artefacts or lack of response on the unaffected side. Both techniques yielded concordant results in 73% of the patients. In 12 patients, CEPs yielded abnormal values while LEPs remained within normal limits; 3 of these patients had clinical symptoms limited to cold sensations, including cold‐heat transformation.ConclusionsCEPs appear as a useful technique for exploring pain/temperature systems. Advantages are low cost of equipment and innocuity. Disadvantages are low signal‐to‐noise ratio for LL stimulation, and sensitivity to fatigue/habituation. Joint recording of CEPs and LEPs can increase the sensitivity of neurophysiological techniques to thin fibre‐ spinothalamic lesions, in particular, when abnormalities of cold perception predominate.SignificanceRecording of cold‐evoked potentials is a well‐tolerated, inexpensive and easy‐to‐use procedure that can be helpful in the diagnosis of abnormalities in the thin fibre‐ spinothalamic pathways. Supplementing LEPs with CEPs allows consolidating the diagnosis and, for some patients suffering from symptoms limited only to cold, CEPs but not LEPs may allow the diagnosis of thin fibre pathology. Optimal CEP recording conditions are important to overcome the low signal‐to‐noise ratio and habituation phenomena, which are less favourable than with LEPs.

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Section: Resultsmentioning

confidence: 93%

Cold‐evoked potentials in clinical practice: A head‐to‐head contrast with laser‐evoked responses

Perchet

Hagiwara

Salameh

et al. 2023

European Journal of Pain

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“…However, the effects of analgesic medications are poor to moderate ( 21 ). There is not a single type of pain in MS and many different types have been suggested ( 22 ), including neuropathic pain ( 23 ) such as trigeminal neuralgia ( 14 ). Therefore, pain assessment in MS patients should be multidimensional in order to choose the best treatment ( 21 ) as well as using the fewest number of drugs to avoid polytherapy.…”

Section: Discussionmentioning

confidence: 99%

Spasticity-Plus syndrome in multiple sclerosis patients in a tertiary hospital in Spain

Goicochea Briceño,

Higueras,

Ruiz Pérez

et al. 2024

Front. Neurol.

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IntroductionSpasticity is a common symptom in multiple sclerosis (MS) and it is often associated with other symptoms such as spasms/cramps and pain. The concept of Spasticity-Plus syndrome takes into account that spasticity is accompanied by one or more symptoms (spasms/cramps, pain, bladder dysfunction, sleep disorders, fatigue and/or tremor). As these symptoms share a common cannabinoid control, therapy acting on cannabinoid receptors may be useful. The main study objectives were to determine the number of MS patients who met Spasticity-Plus syndrome criteria and to identify the most common symptoms.MethodsClinical records of MS patients treated with nabiximols in a tertiary hospital from 2002 to 2022 were reviewed retrospectively.ResultsOf the 73 patients included in the study, 53.4% were women, and most had secondary progressive MS (64.4%). All patients met the criteria for Spasticity-Plus syndrome: 100% had spasticity and at least another symptom. Pain was the second most common symptom (91.8%), followed by spasms/cramps (79.4%), and fatigue (76.7%). Sleep disturbances (p < 0.0001) and tremor (p < 0.027) were more frequent in patients with relapsing–remitting MS than in patients with progressive MS. No statistically significant differences were found for spasticity, pain, spasms/cramps, and fatigue between MS phenotypes. Regarding symptoms clusters, 94.4% of the patients had three or more symptoms. Spasticity was more frequently associated with pain (91.8%) and spasms/cramps (79.4%).ConclusionSpasticity-Plus syndrome was present in all the study population of patients with different MS phenotypes, and treated with nabiximols.

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“…НБ при РС асоціювався з достовірно більш високими показниками шкали EDSS, порівняно з пацієнтами без болю [16,22,23]; пацієнти з НБ, за опитувальником DN4 мали середній показник шкали EDSS 4 бали, тоді як пацієнти без болю -2 бали [12]. Більше того, НБ при РС асоціювався з достовірно більш високими показниками шкали EDSS, порівняно з пацієнтами, які мали ноцицептивний біль [23].…”

Section: актуальні проблеми сучасної медициниunclassified

Predictors of Neuropathic Pain in Patients With Multiple Sclerosis (Cross-Sectional Study)

Delva¹,

Skoryk²

2022

Act. Probl. of the Modern Med.

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Neuropathic pain in multiple sclerosis is a common phenomenon and is accompanied by numerous negative consequences, which significantly reduces their quality of life and increases the degree of disability. The purpose of this study is to study the factors that act as predictors of neuropathic pain in patients with multiple sclerosis. Were involved in the research process. 321 patients with multiple sclerosis - 110 men (34.3%) and 211 women (65.7%), aged 21 to 55 years. Among the characteristics of multiple sclerosis, the age of the patient when diagnosed, the duration of the disease, the type of course, and the total assessment of neurological deficit were determined. Appropriate scales were used to determine the type and duration of pain, socio-demographic, psychopathological, statistical research methods and comorbid pathology was taken into account. It was established that female gender is a predictor of central dysesthesias in neuropathic pain - 2.61 (1.06-6.42; p=0.04). It was also found that the factors of dysesthesias of central origin are subclinical anxiety disorders - 2.66 (1.19-5.92; p=0.02) and subclinical depressive disorders - 2.92 (1.31-6.49; p=0.02). p=0.01). Predictors of dysesthesias of central genesis are an increase in the duration of multiple sclerosis for each subsequent year - 1.07 (1.02-1.14; p=0.01), progressive type of multiple sclerosis - 5.78 (2.45-13.59; p= 0.001) and an increase in Expanded Disability Status Scale indicators for each subsequent 0.5 points – 1.03 (1.01-1.06; p=0.01). Early, correction of subclinical anxiety and depressive disorders as predictors of modifiable central neuropathic pain is likely for adequate management of neuropathic pain in multiple sclerosis. Patients with advanced type of multiple sclerosis, especially those with a high score on the Expanded Disability Status Scale are a group at increased risk of central neuropathic pain and, accordingly, require more careful monitoring with the aim of early detection and correction of dysesthesias, which will positively affect the quality of life of patients. Patients with progressive type of multiple sclerosis, especially those with a high score on the Expanded Disability Status Scale are a group at increased risk of central neuropathic pain and, accordingly, require more careful monitoring with the aim of early detection and correction of dysesthesias, which will positively affect the quality of life of patients.

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Unique features of central neuropathic pain in multiple sclerosis: Results of a cluster analysis

Cited by 16 publications

References 67 publications

Cold‐evoked potentials in clinical practice: A head‐to‐head contrast with laser‐evoked responses

Cold‐evoked potentials in clinical practice: A head‐to‐head contrast with laser‐evoked responses

Spasticity-Plus syndrome in multiple sclerosis patients in a tertiary hospital in Spain

Predictors of Neuropathic Pain in Patients With Multiple Sclerosis (Cross-Sectional Study)

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