Volume 2, Issue 2, March 2014, Page: 20-25
Chronic Pain in Multiple Sclerosis: An Overview
A. R. M. Saifuddin Ekram, Department of Medicine, Rajshahi Medical College, Rajshahi-6000, Bangladesh; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
Ng Louisa, Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road Parkville, Melbourne, VIC 3052, Australia
Bhasker Amatya, Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road Parkville, Melbourne, VIC 3052, Australia
Fary Khan, Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road Parkville, Melbourne, VIC 3052, Australia
Received: Feb. 9, 2014;       Published: Mar. 20, 2014
DOI: 10.11648/j.ajim.20140202.13      View  2967      Downloads  226
The pathophysiology of pain in multiple sclerosis (MS) is poorly understood, but there are multiple schools of thought. Different mechanisms are associated with causation of this pain e.g. acute pain due to inflammation; chronic or intermittent neuropathic pain related to central nervous system (CNS) lesions; pain secondary to spasticity, spasms and muscle cramps from higher motor neuron lesions; and musculoskeletal pain from adopting maladaptive body positions and general physical deconditioning. Similarly evidence for treating pain in MS is limited. Treatment is often based on anecdotal reports and clinical experience as there is scarcity of randomized placebo-controlled trials for evidence of pharmacological treatment of pain in MS. The aim of this article is to provide a brief review of current concepts about the nature, causes and management of pain in MS.
Multiple Sclerosis, Chronic Pain, Neuropathic Pain
To cite this article
A. R. M. Saifuddin Ekram, Ng Louisa, Bhasker Amatya, Fary Khan, Chronic Pain in Multiple Sclerosis: An Overview, American Journal of Internal Medicine. Vol. 2, No. 2, 2014, pp. 20-25. doi: 10.11648/j.ajim.20140202.13
Compston, A. and A. Coles, Multiple sclerosis. Lancet, 2002. 359(9313): p. 1221-31.
Frohman, E.M., et al., The utility of MRI in suspected MS: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 2003. 61(5): p. 602-11.
Alonso, A. and M.A. Hernan, Temporal trends in the incidence of multiple sclerosis: a systematic review. Neurology, 2008. 71(2): p. 129-35.
Programme for Neurological Disease and Neurosciences Department of Mental Health and Substance Abuse, Atlas: Country Resources for Neurological Disorders: Results of a Collaborative Study of World Health Organization and World Federation of Neurology, World Health Organization, Geneva, Switzerland, 2004.
Aring, C.D., Pain in multiple sclerosis. JAMA, 1973. 223(5): p. 547.
Archibald, C.J., et al., Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients. Pain, 1994. 58(1): p. 89-93.
Svendsen, K.B., et al., Sensory function and quality of life in patients with multiple sclerosis and pain. Pain, 2005. 114(3): p. 473-81.
Beiske, A.G., et al., Pain and sensory complaints in multiple sclerosis. Eur J Neurol, 2004. 11(7): p. 479-82.
Solaro, C., et al., The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study. Neurology, 2004. 63(5): p. 919-21.
Stenager, E., L. Knudsen, and K. Jensen, Acute and chronic pain syndromes in multiple sclerosis. Acta Neurol Scand, 1991. 84(3): p. 197-200.
Vermote, R., P. Ketelaer, and H. Carton, Pain in multiple sclerosis patients. A prospective study using the Mc Gill Pain Questionnaire. Clin Neurol Neurosurg, 1986. 88(2): p. 87-93.
Foley, P.L., et al., Prevalence and natural history of pain in adults with multiple sclerosis: Systematic review and meta-analysis. Pain, 2012.
O'Connor, A.B., et al., Pain associated with multiple sclerosis: systematic review and proposed classification. Pain, 2008. 137(1): p. 96-111.
Truini, A., et al., "A mechanism-based classification of pain in multiple sclerosis." J Neurol, 2013. 260(2): 351-367.
Osterberg, A., J. Boivie, and K.A. Thuomas, Central pain in multiple sclerosis--prevalence and clinical characteristics. Eur J Pain, 2005. 9(5): p. 531-42.
Lalkhen, A.G., J.P. Bedford, and A.D. Dwyer, Pain associated with multiple sclerosis: epidemiology, classification and management. British Journal of Neuroscience Nursing, 2012. 8(5): p. 267-74.
Moulin, D.E., Pain in central and peripheral demyelinating disorders. Neurol Clin, 1998. 16(4): p. 889-98.
Al-Araji, A.H. and J. Oger, Reappraisal of Lhermitte's sign in multiple sclerosis. Mult Scler, 2005. 11(4): p. 398-402.
Manzoni, G.C. and P. Torelli, Epidemiology of typical and atypical craniofacial neuralgias. Neurol Sci, 2005. 26 Suppl 2: p. s65-7.
Mueller, D., et al., Prevalence of trigeminal neuralgia and persistent idiopathic facial pain: a population-based study. Cephalalgia, 2011. 31(15): p. 1542-8.
Putzki, N., et al., Prevalence of migraine, tension-type headache and trigeminal neuralgia in multiple sclerosis. Eur J Neurol, 2009. 16(2): p. 262-7.
Obermann, M. and Z. Katsarava, Update on trigeminal neuralgia. Expert Rev Neurother, 2009. 9(3): p. 323-9.
Clifford, D.B. and J.L. Trotter, Pain in multiple sclerosis. Arch Neurol, 1984. 41(12): p. 1270-2.
Moulin, D.E., Pain in multiple sclerosis. Neurol Clin, 1989. 7(2): p. 321-31.
Kassirer, M.R. and D.H. Osterberg, Pain in chronic multiple sclerosis. J Pain Symptom Manage, 1987. 2(2): p. 95-7.
Maloni, H.W., Pain in multiple sclerosis: an overview of its nature and management. J Neurosci Nurs, 2000. 32(3): p. 139-44, 152.
Thompson, A.J., Multiple sclerosis: symptomatic treatment. J Neurol, 1996. 243(8): p. 559-65.
Matthews, W.B., Paroxysmal symptoms in multiple sclerosis. J Neurol Neurosurg Psychiatry, 1975. 38(6): p. 617-23.
Rolak, L.A. and S. Brown, Headaches and multiple sclerosis: a clinical study and review of the literature. J Neurol, 1990. 237(5): p. 300-2.
Kister, I., et al., Tension-type headache and migraine in multiple sclerosis. Curr Pain Headache Rep, 2010. 14(6): p. 441-8.
Kister, I., et al., Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course. J Headache Pain, 2010. 11(5): p. 417-25.
Martinelli Boneschi, F., et al., Lifetime and actual prevalence of pain and headache in multiple sclerosis. Mult Scler, 2008. 14(4): p. 514-21.
Solaro, C. and M. Messmer Uccelli, Pharmacological management of pain in patients with multiple sclerosis. Drugs, 2010. 70(10): p. 1245-54.
Attal, N., et al., EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol, 2010. 17(9): p. 1113-e88.
Tan, T., et al., Pharmacological management of neuropathic pain in non-specialist settings: summary of NICE guidance. Bmj, 2010. 340: p. c1079.
Solaro, C., et al., Gabapentin is effective in treating nocturnal painful spasms in multiple sclerosis. Mult Scler, 2000. 6(3): p. 192-3.
Restivo, D.A., et al., Botulinum toxin treatment of painful tonic spasms in multiple sclerosis. Neurology, 2003. 61(5): p. 719-20.
Al-Smadi, J., et al., A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis. Clin Rehabil, 2003. 17(7): p. 742-9.
Espir, M.L. and P. Millac, Treatment of paroxysmal disorders in multiple sclerosis with carbamazepine (Tegretol). J Neurol Neurosurg Psychiatry, 1970. 33(4): p. 528-31.
Khan, O.A., Gabapentin relieves trigeminal neuralgia in multiple sclerosis patients. Neurology, 1998. 51(2): p. 611-4.
Solaro, C., et al., An open-label trial of gabapentin treatment of paroxysmal symptoms in multiple sclerosis patients. Neurology, 1998. 51(2): p. 609-11.
Zvartau-Hind, M., et al., Topiramate relieves refractory trigeminal neuralgia in MS patients. Neurology, 2000. 55(10): p. 1587-8.
Solaro, C., et al., Topiramate relieves idiopathic and symptomatic trigeminal neuralgia. J Pain Symptom Manage, 2001. 21(5): p. 367-8.
Reder, A.T. and B.G. Arnason, Trigeminal neuralgia in multiple sclerosis relieved by a prostaglandin E analogue. Neurology, 1995. 45(6): p. 1097-100.
Misoprostol in the treatment of trigeminal neuralgia associated with multiple sclerosis. J Neurol, 2003. 250(5): p. 542-5.
Bowling, A.C. and T.M. Stewart, Current Complementary and Alternative Therapies for Multiple Sclerosis. Curr Treat Options Neurol, 2003. 5(1): p. 55-68.
Eisenberg, D.M., et al., Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med, 1993. 328(4): p. 246-52.
Eisenberg, D.M., et al., Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. Jama, 1998. 280(18): p. 1569-75.
Jensen, M.P., et al., A comparison of self-hypnosis versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain. Int J Clin Exp Hypn, 2009. 57(2): p. 198-221.
Apel, A., B. Greim, and U.K. Zettl, How frequently do patients with multiple sclerosis use complementary and alternative medicine? Complement Ther Med, 2005. 13(4): p. 258-63.
Murray, T.J., Complementary and alternative medicine for MS. Int MS J, 2006. 13(1): p. 3.
Carlson, M.J. and G. Krahn, Use of complementary and alternative medicine practitioners by people with physical disabilities: estimates from a National US Survey. Disabil Rehabil, 2006. 28(8): p. 505-13.
Hughes, C.M., S. Smyth, and A.S. Lowe-Strong, Reflexology for the treatment of pain in people with multiple sclerosis: a double-blind randomised sham-controlled clinical trial. Mult Scler, 2009. 15(11): p. 1329-38.
Huntley, A. and E. Ernst, Complementary and alternative therapies for treating multiple sclerosis symptoms: a systematic review. Complement Ther Med, 2000. 8(2): p. 97-105.
Nayak, S., et al., Use of unconventional therapies by individuals with multiple sclerosis. Clin Rehabil, 2003. 17(2): p. 181-91.
Khan, F. and J. Pallant, Chronic pain in multiple sclerosis: prevalence, characteristics, and impact on quality of life in an Australian community cohort. J Pain, 2007. 8(8): p. 614-23.
Khan, F., B. Amatya, and J. Kesselring, Longitudinal 7-year follow-up of chronic pain in persons with multiple sclerosis in the community. J Neurol, 2013. 260(8): p. 2005-15.
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