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Chapter 31 - Multiple Sclerosis Pain

from Part VI - Misc

Published online by Cambridge University Press:  01 December 2023

Omar Viswanath
Affiliation:
Creighton University, Omaha
Ivan Urits
Affiliation:
Southcoast Brain & Spine Center, Wareham
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Summary

Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system, causing inflammation with oligodendrocyte death and myelin sheath destruction. Classical symptoms of MS are fatigue, paresthesia, motor deficits, cognitive dysfunction, visual disturbances (due to optic neuritis), spasticity, depression, gait disturbance, and pain. To make a formal diagnosis of MS, the 2017 McDonald criteria is used. Pain in MS can present itself as headache, extremity pain, back pain, neuropathic pain, or more specifically, trigeminal neuralgia. Pain in MS can be severe and chronic enough to cause disability and decreased quality of life. The prevalence of neuropathic pain in MS can be as high as 86% and it can manifest itself as back pain, headache, trigeminal neuralgia, or extremity pain. When present, it is associated with MS, which tends to be more severe, with a higher degree of disability. Early treatment of these pains leads to better outcomes of MS itself. Conventional methods to treat pain in these patients produce only a 50% reduction in symptomatology. Some unconventional treatment modalities that have benefited patients are antidepressants, anticonvulsants, cannabinoids, low-dose naltrexone, and spinal stimulation.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Ghasemi, N, Razavi, S, Nikzad, E. Multiple sclerosis: Pathogenesis, symptoms, diagnoses and cell-based therapy. Cell J. 2017;19(1):110. https://doi.org/10.22074/cellj.2016.4867.Google ScholarPubMed
Monteleone, F, Nicoletti, CG, Stampanoni Bassi, M et al. Nerve growth factor is elevated in the CSF of patients with multiple sclerosis and central neuropathic pain. J Neuroimmunol. 2018;314:8993. https://doi.org/10.1016/j.jneuroim.2017.11.012.CrossRefGoogle ScholarPubMed
Kalia, LV, O’Connor, PW. Severity of chronic pain and its relationship to quality of life in multiple sclerosis. Mult Scler. 2005;11(3):322327. https://doi.org/10.1191/1352458505ms1168oa.CrossRefGoogle ScholarPubMed
Young, J, Amatya, B, Galea, MP, Khan, F. Chronic pain in multiple sclerosis: A 10-year longitudinal study. Scand J Pain. 2017;16:198203. https://doi.org/10.1016/j.sjpain.2017.04.070.CrossRefGoogle ScholarPubMed
Fallata, A, Salter, A, Tyry, T, Cutter, GR, Marrie, RA. Trigeminal neuralgia commonly precedes the diagnosis of multiple sclerosis. Int J MS Care. 2017;19(5):240246. https://doi.org/10.7224/1537-2073.2016-065.CrossRefGoogle ScholarPubMed
Zakrzewska, JM, Wu, J, Brathwaite, TSL. A systematic review of the management of trigeminal neuralgia in patients with multiple sclerosis. World Neurosurg. 2018;111:291306. https://doi.org/10.1016/j.wneu.2017.12.147.CrossRefGoogle ScholarPubMed
Xu, Z, Mathieu, D, Heroux, F et al. Stereotactic radiosurgery for trigeminal neuralgia in patients with multiple sclerosis: A multicenter study. Neurosurgery. 2019;84(2):499505. https://doi.org/10.1093/neuros/nyy142.CrossRefGoogle ScholarPubMed
La Mantia, L, Prone, V. Headache in multiple sclerosis and autoimmune disorders. Neurol Sci. 2015;36(Suppl 1):7578. https://doi.org/10.1007/s10072-015-2146-9.CrossRefGoogle ScholarPubMed
Husain, F, Pardo, G, Rabadi, M. Headache and its management in patients with multiple sclerosis. Curr Treat Options Neurol. 2018;20(4):10. https://doi.org/10.1007/s11940-018-0495-4.CrossRefGoogle ScholarPubMed
Murphy, KL, Bethea, JR, Fischer, R. Neuropathic pain in multiple sclerosis: Current therapeutic intervention and future treatment perspectives. In: Zagon, IS, McLaughlin, PJ, eds. Multiple Sclerosis: Perspectives in Treatment and Pathogenesis. Brisbane: Codon Publications. 2017.Google ScholarPubMed
Solaro, C, Cella, M, Signori, A et al. Identifying neuropathic pain in patients with multiple sclerosis: A cross-sectional multicenter study using highly specific criteria. J Neurol. 2018;265(4):828835. https://doi.org/10.1007/s00415-018-8758-2.CrossRefGoogle ScholarPubMed
Heitmann, H, Biberacher, V, Tiemann, L et al. Prevalence of neuropathic pain in early multiple sclerosis. Mult Scler. 2016;22(9):12241230. https://doi.org/10.1177/1352458515613643.CrossRefGoogle ScholarPubMed
Rice, J, Cameron, M. Cannabinoids for treatment of MS symptoms: State of the evidence. Curr Neurol Neurosci Rep. 2018;18(8):50. https://doi.org/10.1007/s11910-018-0859-x.CrossRefGoogle ScholarPubMed
Landa, L, Jurica, J, Sliva, J, Pechackova, M, Demlova, R. Medical cannabis in the treatment of cancer pain and spastic conditions and options of drug delivery in clinical practice. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018;162(1):1825. https://doi.org/10.5507/bp.2018.007.CrossRefGoogle ScholarPubMed
Jitpakdee, T, Mandee, S. Strategies for preventing side effects of systemic opioid in postoperative pediatric patients. Paediatr Anaesth. 2014;24(6):561568. https://doi.org/10.1111/pan.12420.CrossRefGoogle ScholarPubMed
Demaneuf, T, Aitken, Z, Karahalios, A et al. Effectiveness of exercise interventions for pain reduction in people with multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2019;100(1):128139. https://doi.org/10.1016/j.apmr.2018.08.178.CrossRefGoogle ScholarPubMed
Kahraman, T, Ozdogar, AT, Yigit, P et al. Feasibility of a 6-month yoga program to improve the physical and psychosocial status of persons with multiple sclerosis and their family members. Explore (NY). 2018;14(1):3643. https://doi.org/10.1016/j.explore.2017.07.006.CrossRefGoogle ScholarPubMed
Abboud, H, Hill, E, Siddiqui, J, Serra, A, Walter, B. Neuromodulation in multiple sclerosis. Mult Scler. 2017;23(13):16631676. https://doi.org/10.1177/1352458517736150.CrossRefGoogle ScholarPubMed
Urits, I, Adamian, L, Fiocchi, J et al. Advances in the understanding and management of chronic pain in multiple sclerosis: A comprehensive review. Curr Pain Headache Rep. 2019;23(8):59. https://doi.org/10.1007/s11916-019-0800-2.CrossRefGoogle ScholarPubMed

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