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Huerta MÁ, Cisneros E, Alique M, Roza C. Strategies for measuring non-evoked pain in preclinical models of neuropathic pain: Systematic review. Neurosci Biobehav Rev 2024; 163:105761. [PMID: 38852847 DOI: 10.1016/j.neubiorev.2024.105761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
The development of new analgesics for neuropathic pain treatment is crucial. The failure of promising drugs in clinical trials may be related to the over-reliance on reflex-based responses (evoked pain) in preclinical drug testing, which may not fully represent clinical neuropathic pain, characterized by spontaneous non-evoked pain (NEP). Hence, strategies for assessing NEP in preclinical studies emerged. This systematic review identified 443 articles evaluating NEP in neuropathic pain models (mainly traumatic nerve injuries in male rodents). An exponential growth in NEP evaluation was observed, which was assessed using 48 different tests classified in 12 NEP-related outcomes: anxiety, exploration/locomotion, paw lifting, depression, conditioned place preference, gait, autotomy, wellbeing, facial grooming, cognitive impairment, facial pain expressions and vocalizations. Although most of these outcomes showed clear limitations, our analysis suggests that conditioning-associated outcomes, pain-related comorbidities, and gait evaluation may be the most effective strategies. Moreover, a minimal part of the studies evaluated standard analgesics. The greater emphasis on evaluating NEP aligning with clinical pain symptoms may enhance analgesic drug development, improving clinical translation.
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Affiliation(s)
- Miguel Á Huerta
- Department of Pharmacology, Faculty of Medicine, University of Granada, Granada 18016, Spain; Institute of Neuroscience, Biomedical Research Center, University of Granada, 18100 Armilla, Granada, Spain; Biosanitary Research Institute ibs.GRANADA, Granada 18012, Spain
| | - Elsa Cisneros
- Health Sciences School, Centro Universitario Internacional de Madrid (CUNIMAD), Madrid, Spain; Health Sciences School, Universidad Internacional de La Rioja (UNIR), Logroño, Spain
| | - Matilde Alique
- Department of System's Biology, Medical School, University of Alcala de Henares, Alcalá de Henares, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid 28034, Spain
| | - Carolina Roza
- Department of System's Biology, Medical School, University of Alcala de Henares, Alcalá de Henares, Spain.
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2
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Díaz-Molina J, Orduna J, Rivero D, Alcázar P, González LM. Partial sensory rhizotomy in recurrent trigeminal neuralgia. Our experience and literature review. NEUROCIRUGIA (ENGLISH EDITION) 2024:S2529-8496(24)00038-8. [PMID: 38972389 DOI: 10.1016/j.neucie.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Trigeminal Neuralgia (NT) is a common pathology in Neurosurgery. It can be classified as idiopathic or secondary to other pathologies, such as Multiple Sclerosis (MS). Several surgical treatments have been described, some of them being replaced by more modern techniques. Partial sensory rhizotomy (PSR), described by Dandy is a technique replaced by other techniques due to its permanent side effects. We present our experience with this technique in patients with recurrent NT. METHODS AND MATERIALS A retrospective review is carried out on five patients who underwent surgery at our center from 2018 to 2023 using the PSR technique. RESULTS All the patients intervened showed significant clinical improvement, except one patient who required reintervention due to uncontrolled pain. According to the Barrow Neurological Institute (BNI) scale, 80% (4/5) of patients showed improvement from grade V to grades I/II except for one of them. This patient suffered from MS. Additionally, one patient presented a corneal ulcer after surgery due to impairment of the corneal reflex. CONCLUSION In our experience, PSR is a valid treatment option in selected patients with recurrent TN. It has a low incidence of complications with an adequate surgical technique and anatomical knowledge of the region. To the best of our knowledge, we are one of the few centers in Spain to publish our results with PSR in the last ten years. We report good results in pain control withdrawing medication in 80% (4/5) of the operated patients.
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Affiliation(s)
| | | | - David Rivero
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Paula Alcázar
- Hospital Universitario Miguel Servet, Zaragoza, Spain
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3
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McBenedict B, Goh KS, Yau RCC, Elamin S, Yusuf WH, Verly G, Thomas A, Alphonse B, Ouabicha K, Valentim G, Hauwanga WN, Lima Pessôa B. Neuropathic Pain Secondary to Multiple Sclerosis: A Narrative Review. Cureus 2024; 16:e61587. [PMID: 38962595 PMCID: PMC11221503 DOI: 10.7759/cureus.61587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system (CNS). Neuropathic pain in MS is a debilitating symptom that significantly impairs the quality of life for a substantial proportion of MS patients. Neuropathic pain in MS stems primarily from demyelination, axonal loss, CNS inflammation, and direct damage to the myelin sheath, leading to pain manifestations such as ongoing extremity pain, Lhermitte's phenomenon, and trigeminal neuralgia (TN). The pathophysiological mechanisms behind MS-related neuropathic pain are explored in this review, highlighting central sensitization, neural dysfunction, spinal thalamic tract dysfunction, and inflammatory processes that exacerbate neuronal damage. Neuropathic pain in MS necessitates comprehensive assessment tools and neurophysiological tests to differentiate neuropathic pain from other MS symptoms accurately. Treatment strategies for MS-related neuropathic pain encompass pharmacological interventions, including anticonvulsants and antidepressants, and emerging therapies targeting specific inflammatory processes. The review advocates for a holistic approach to management, incorporating innovative treatments and multidisciplinary strategies to address both the physical symptoms and psychosocial aspects of this disorder. This comprehensive overview underscores the importance of ongoing research into targeted therapies to improve patient outcomes and enhance the quality of life for those affected by MS.
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Affiliation(s)
| | - Kang Suen Goh
- Internal Medicine, Monash University Malaysia, Johor Bahru, MYS
| | | | - Sara Elamin
- Medicine, University of Medical Sciences and Technology, Khartoum, SDN
| | | | - Gabriel Verly
- Neurology, Federal University of Rio de Janeiro, Rio de Janeiro, BRA
| | - Anusha Thomas
- Neurology, Christian Medical College & Hospital, Ludhiana, IND
| | - Berley Alphonse
- Internal Medicine, University Notre Dame of Haiti, Port-au-Prince, HTI
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4
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Pergolizzi JV, LeQuang JAK, El-Tallawy SN, Ahmed RS, Wagner M, Varrassi G. The Challenges in Clinical Diagnosis of Trigeminal Neuralgia: A Review. Cureus 2024; 16:e61898. [PMID: 38978896 PMCID: PMC11228405 DOI: 10.7759/cureus.61898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/07/2024] [Indexed: 07/10/2024] Open
Abstract
The lack of established laboratory tests or biomarkers for trigeminal neuralgia (TN) makes diagnosing this relatively rare condition extremely challenging. Trigeminal nerve compression observable on magnetic resonance imaging may indicate TN, but many patients do not have visible lesions or compression. In particular, TN may be confused with migraine, cluster headache, temporomandibular disorder, and other types of headache. An accurate diagnosis is imperative for proper treatment since these conditions do not respond to the same treatment. Many symptoms of these headaches can be vague or overlap, and clinicians depend in large measure on the subjective reports of their patients. Nevertheless, it is imperative to diagnose TN better, which can cause excruciating pain, reduce the quality of life, and even result in disability. It is possible that TN is underestimated.
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Affiliation(s)
| | | | - Salah N El-Tallawy
- Anesthesia and Pain Management, Faculty of Medicine, Minia University and NCI, Cairo University, Cairo, EGY
- Anesthesia and Pain Management, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, SAU
| | - Rania S Ahmed
- College of Medicine, Alfaisal University, Riyadh, SAU
| | - Morgan Wagner
- Entrepreneur Program, NEMA Research, Inc., Naples, USA
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5
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Minato T, Kawai K, Edamura T, Abe H, Sumitani M. Secondary trigeminal neuralgia caused by lung adenocarcinoma metastasis on trigeminal nerve roots successfully relieved by opioids: A case report. Mol Clin Oncol 2024; 20:26. [PMID: 38414511 PMCID: PMC10895458 DOI: 10.3892/mco.2024.2724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/03/2023] [Indexed: 02/29/2024] Open
Abstract
Secondary trigeminal neuralgia (TN) is caused by identifiable diseases or lesions of the trigeminal nerve root, Gasserian ganglion and/or pons. TN is a neuropathic pain disorder characterized by electric shock-like or stabbing pain in the facial region, which can lead to impaired health-related quality of life. The present case report describes a rare case of secondary TN caused by trigeminal nerve metastases from lung adenocarcinoma, in which opioids provided symptomatic relief. The patient was a 46-year-old man with stage IV lung adenocarcinoma. They were admitted to hospital for the introduction of fifth-line chemotherapy because of previous chemotherapy-refractory disease progression. Electric shock-like or stabbing pain in the left facial area and bilateral auditory disturbances coincided with intracranial peri-brainstem metastases. Facial pain was triggered by mastication, making it difficult for the patient to eat. A fentanyl transdermal patch (25 mcg/h) was initiated following a diagnosis of TN secondary to lung adenocarcinoma metastases on the trigeminal nerves by magnetic resonance imaging. Subsequently, the facial pain improved rapidly. In conclusion, unlike classic and idiopathic TN, which is usually treated with carbamazepine as a first-line drug, oncologic secondary TN can be treated with opioids.
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Affiliation(s)
- Takafumi Minato
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo 113-0033, Japan
| | - Kirio Kawai
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo 113-0033, Japan
| | - Tatsuma Edamura
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo 113-0033, Japan
| | - Hiroaki Abe
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo 113-0033, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo 113-0033, Japan
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6
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Cohen SP, Caterina MJ, Yang SY, Socolovsky M, Sommer C. Pain in the Context of Sensory Deafferentation. Anesthesiology 2024; 140:824-848. [PMID: 38470115 DOI: 10.1097/aln.0000000000004881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Pain that accompanies deafferentation is one of the most mysterious and misunderstood medical conditions. Prevalence rates for the assorted conditions vary considerably but the most reliable estimates are greater than 50% for strokes involving the somatosensory system, brachial plexus avulsions, spinal cord injury, and limb amputation, with controversy surrounding the mechanistic contributions of deafferentation to ensuing neuropathic pain syndromes. Deafferentation pain has also been described for loss of other body parts (e.g., eyes and breasts) and may contribute to between 10% and upwards of 30% of neuropathic symptoms in peripheral neuropathies. There is no pathognomonic test or sign to identify deafferentation pain, and part of the controversy surrounding it stems from the prodigious challenges in differentiating cause and effect. For example, it is unknown whether cortical reorganization causes pain or is a byproduct of pathoanatomical changes accompanying injury, including pain. Similarly, ascertaining whether deafferentation contributes to neuropathic pain, or whether concomitant injury to nerve fibers transmitting pain and touch sensation leads to a deafferentation-like phenotype can be clinically difficult, although a detailed neurologic examination, functional imaging, and psychophysical tests may provide clues. Due in part to the concurrent morbidities, the physical, psychologic, and by extension socioeconomic costs of disorders associated with deafferentation are higher than for other chronic pain conditions. Treatment is symptom-based, with evidence supporting first-line antineuropathic medications such as gabapentinoids and antidepressants. Studies examining noninvasive neuromodulation and virtual reality have yielded mixed results.
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Affiliation(s)
- Steven P Cohen
- Departments of Anesthesiology, Neurology, Physical Medicine and Rehabilitation, Psychiatry and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Departments of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Michael J Caterina
- Neurosurgery Pain Research Institute and Department of Biological Chemistry, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Su-Yin Yang
- Psychology Service, Woodlands Health, and Adjunct Faculty, Lee Kong Chian School of Medicine, Singapore
| | - Mariano Socolovsky
- Department of Neurosurgery, University of Buenos Aires, Buenos Aires, Argentina
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7
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Shkodina AD, Bardhan M, Chopra H, Anyagwa OE, Pinchuk VA, Hryn KV, Kryvchun AM, Boiko DI, Suresh V, Verma A, Delva MY. Pharmacological and Non-pharmacological Approaches for the Management of Neuropathic Pain in Multiple Sclerosis. CNS Drugs 2024; 38:205-224. [PMID: 38421578 DOI: 10.1007/s40263-024-01072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Multiple sclerosis is a chronic inflammatory disease that affects the central nervous system and can cause various types of pain including ongoing extremity pain, Lhermitte's phenomenon, trigeminal neuralgia, and mixed pain. Neuropathic pain is a major concern for individuals with multiple sclerosis as it is directly linked to myelin damage in the central nervous system and the management of neuropathic pain in multiple sclerosis is challenging as the options available have limited efficacy and can cause unpleasant side effects. The literature search was conducted across two databases, PubMed, and Google Scholar. Eligible studies included clinical trials, observational studies, meta-analyses, systematic reviews, and narrative reviews. The objective of this article is to provide an overview of literature on pharmacological and non-pharmacological strategies employed in the management of neuropathic pain in multiple sclerosis. Pharmacological options include cannabinoids, muscle relaxants (tizanidine, baclofen, dantrolene), anticonvulsants (benzodiazepines, gabapentin, phenytoin, carbamazepine, lamotrigine), antidepressants (duloxetine, venlafaxine, tricyclic antidepressants), opioids (naltrexone), and botulinum toxin variants, which have evidence from various clinical trials. Non-pharmacological approaches for trigeminal neuralgia may include neurosurgical methods. Non-invasive methods, physical therapy, and psychotherapy (cognitive behavioral therapy, acceptance and commitment therapy and mindfulness-based stress reduction) may be recommended for patients with neuropathic pain in multiple sclerosis. The choice of treatment depends on the severity and type of pain as well as other factors, such as patient preferences and comorbidities. There is a pressing need for healthcare professionals and researchers to prioritize the development of better strategies for managing multiple sclerosis-induced neuropathic pain.
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Affiliation(s)
- Anastasiia D Shkodina
- Department of Neurological diseases, Poltava State Medical University, Poltava, Ukraine
| | - Mainak Bardhan
- Neuro Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, 8900 N. Kendall Drive, Miami, FL, 33176, USA.
| | - Hitesh Chopra
- Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, 602105, Tamil Nadu, India
| | | | - Viktoriia A Pinchuk
- Department of Neurological diseases, Poltava State Medical University, Poltava, Ukraine
| | - Kateryna V Hryn
- Department of Neurological diseases, Poltava State Medical University, Poltava, Ukraine
| | - Anzhelina M Kryvchun
- Department of Neurological diseases, Poltava State Medical University, Poltava, Ukraine
| | - Dmytro I Boiko
- Department of Psychiatry, Narcology and Medical Psychology, Poltava State Medical University, Poltava, Ukraine
| | - Vinay Suresh
- King George's Medical University, Lucknow, India
| | - Amogh Verma
- Rama Medical College Hospital and Research Centre, Hapur, India
| | - Mykhailo Yu Delva
- Department of Neurological diseases, Poltava State Medical University, Poltava, Ukraine
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8
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Goicochea Briceño H, Higueras Y, Ruiz Pérez I, García Domínguez JM, Cuello JP, Meldaña Rivera A, Martínez Ginés ML. Spasticity-Plus syndrome in multiple sclerosis patients in a tertiary hospital in Spain. Front Neurol 2024; 15:1360032. [PMID: 38469589 PMCID: PMC10926473 DOI: 10.3389/fneur.2024.1360032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Spasticity 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. Methods Clinical records of MS patients treated with nabiximols in a tertiary hospital from 2002 to 2022 were reviewed retrospectively. Results Of 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%). Conclusion Spasticity-Plus syndrome was present in all the study population of patients with different MS phenotypes, and treated with nabiximols.
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Affiliation(s)
| | - Yolanda Higueras
- Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Irene Ruiz Pérez
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Juan Pablo Cuello
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ariana Meldaña Rivera
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
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9
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Rivel M, Achiron A, Stern Y, Zeilig G, Defrin R. Emotional burden among MS patients: associations between specific chronic pain diagnoses and psychological features. J Neurol 2024; 271:688-698. [PMID: 37875677 DOI: 10.1007/s00415-023-12048-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
Central neuropathic pain (CNP) and musculoskeletal pain (MSP) are often comorbid with multiple sclerosis (MS), yet data on the emotional burden entailed by this comorbidity are very limited. We studied whether MS patients with CNP exhibited greater emotional burden and pain severity than those with MSP and whether this emotional burden was attributed to the MS, the chronic pain, or both. Participants were 125 MS patients (55 with CNP; 30 with MSP; 40 MS pain-free) and 30 healthy controls (HCs). Participants completed questionnaires assessing pain interference, pain catastrophizing, depression, anxiety, stress, hypervigilance, and chronic pain. Group comparisons and a two-step cluster analysis were performed, and the association between cluster membership and clinical group membership was evaluated. Chronic pain was stronger and more widespread in the CNP group than in the MSP group. Both pain groups had higher pain interference, pain catastrophizing, and stress compared to MS pain-free and HC groups. All MS groups had greater depression levels compared to HCs, and the CNP group had the highest anxiety level. The "high psychological distress" cluster comprised mainly participants with CNP (57%), and the "minimal psychological distress" cluster comprised mainly the MS pain-free and HC groups. In conclusion, CNP seems to induce greater emotional burden and pain severity than does MSP. Whereas depression may be attributed to MS, and anxiety to CNP, enhanced pain interference, catastrophizing, and stress may be attributed to the comorbidity of MS and chronic pain. Identifying these traits among MS patients and targeting them in management programs may contribute to more effective, individually based care.
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Affiliation(s)
- Michal Rivel
- Department of Physical Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anat Achiron
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Stern
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Gabi Zeilig
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurological Rehabilitation, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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10
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Nguyen KL, Bhatt IJ, Gupta S, Showkat N, Swanson KA, Fischer R, Kontermann RE, Pfizenmaier K, Bracchi-Ricard V, Bethea JR. Tumor necrosis factor receptor 2 activation elicits sex-specific effects on cortical myelin proteins and functional recovery in a model of multiple sclerosis. Brain Res Bull 2024; 207:110885. [PMID: 38246200 PMCID: PMC10923072 DOI: 10.1016/j.brainresbull.2024.110885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/23/2024]
Abstract
Multiple sclerosis (MS), a demyelinating autoimmune disease of the central nervous system (CNS), predominately affects females compared to males. Tumor necrosis factor (TNF), a pro-inflammatory cytokine, signaling through TNF receptor 1 contributes to inflammatory disease pathogenesis. In contrast, TNF receptor 2 signaling is neuroprotective. Current anti-TNF MS therapies are shown to be detrimental to patients due to pleiotropic effects on both pro- and anti-inflammatory functions. Using a non-pertussis toxin (nPTX) experimental autoimmune encephalomyelitis (EAE) model in C57BL/6 mice, we systemically administered a TNFR2 agonist (p53-sc-mTNFR2) to investigate behavioral and pathophysiological changes in both female and male mice. Our data shows that TNFR2 activation alleviates motor and sensory symptoms in females. However, in males, the agonist only alleviates sensory symptoms and not motor. nPTX EAE induction in TNFR2 global knockout mice caused exacerbated motor symptoms in females along with an earlier day of onset, but not in males. Our data demonstrates that TNFR2 agonist efficacy is sex-specific for alleviation of motor symptoms, however, it effectively reduces mechanical hypersensitivity in both females and males. Altogether, these data support the therapeutic promise TNFR2 agonism holds as an MS therapeutic and, more broadly, to treat central neuropathic pain.
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MESH Headings
- Humans
- Male
- Female
- Mice
- Animals
- Multiple Sclerosis
- Receptors, Tumor Necrosis Factor, Type II/agonists
- Receptors, Tumor Necrosis Factor, Type II/metabolism
- Receptors, Tumor Necrosis Factor, Type II/therapeutic use
- Tumor Necrosis Factor Inhibitors/therapeutic use
- Mice, Inbred C57BL
- Encephalomyelitis, Autoimmune, Experimental/drug therapy
- Encephalomyelitis, Autoimmune, Experimental/metabolism
- Myelin Proteins
- Tumor Necrosis Factor-alpha/metabolism
- Mice, Knockout
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Affiliation(s)
- Kayla L Nguyen
- Department of Anatomy and Cell Biology, The George Washington University, Washington, DC 20052, United States.
| | - Ishaan J Bhatt
- Department of Biology, Drexel University, Philadelphia, PA 19104, United States
| | - Shruti Gupta
- Department of Biology, Drexel University, Philadelphia, PA 19104, United States
| | - Nazaf Showkat
- Department of Biology, Drexel University, Philadelphia, PA 19104, United States
| | - Kathryn A Swanson
- Department of Biology, Drexel University, Philadelphia, PA 19104, United States
| | - Roman Fischer
- Institute of Cell Biology and Immunology, University of Stuttgart, 70569 Stuttgart, Germany
| | - Roland E Kontermann
- Institute of Cell Biology and Immunology, University of Stuttgart, 70569 Stuttgart, Germany; Stuttgart Research Center Systems Biology, University of Stuttgart, 70569 Stuttgart, Germany
| | - Klaus Pfizenmaier
- Institute of Cell Biology and Immunology, University of Stuttgart, 70569 Stuttgart, Germany; Stuttgart Research Center Systems Biology, University of Stuttgart, 70569 Stuttgart, Germany
| | | | - John R Bethea
- Department of Anatomy and Cell Biology, The George Washington University, Washington, DC 20052, United States.
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11
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Ouyang H, Li X, Xu H, Zhan Y, Zheng Z, Chen G, Lou Z, Chen H, Zhang J, Mao H, Zhang C, Qin L, Zhao Y, Zhao M. Risk factors of neuropathic pain in multiple sclerosis: a retrospective case-cohort study. Front Immunol 2024; 15:1309583. [PMID: 38352863 PMCID: PMC10863040 DOI: 10.3389/fimmu.2024.1309583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024] Open
Abstract
Background Pain is a common symptom in multiple sclerosis (MS), especially neuropathic pain, which has a significant impact on patients' mental and physical health and quality of life. However, risk factors that related to neuropathic pain, still remain unclear. Objective The study aimed to explore the risk factors of neuropathic pain among MS patients. Materials and methods This retrospective study examined the consecutive patients diagnosed with MS in the Department of Neurology of Guangdong Provincial Hospital of Chinese Medicine between August 2011 and October 2022. Neuropathic pain was defined as "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system". Demographic and clinical features were obtained from the electronic system of the hospital. Results Our cohort revealed that the prevalence of patients with neuropathic pain in MS was 34.1%. The results indicated that the longer the spinal lesions, the greater the neuropathic pain risks (2-4: OR, 13.3(2.1-82), >5: OR, 15.2(2.7-86.8), p for tread: 0.037). Meanwhile, multivariate regression analysis showed that cervical and thoracic lesions (OR 4.276, 95% CI 1.366-13.382, P = 0.013), upper thoracic lesions (T1-T6) (OR 3.047, 95% CI 1.018-9.124, P = 0.046) were positively correlated with neuropathic pain, while basal ganglia lesions (OR 0.188, 95% CI 0.044-0.809, P = 0.025) were negatively correlated with neuropathic pain among MS patients. Conclusion Extended spinal lesions (≥3 spinal lesions), cervical and thoracic lesions, upper thoracic lesions were independent risk factors of neuropathic pain among MS patients. Furthermore, our study found that the longer the spinal lesions, the greater the neuropathic pain risks.
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Affiliation(s)
- Huiying Ouyang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaojun Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haoyou Xu
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yibo Zhan
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zequan Zheng
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Guixian Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhenzhen Lou
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haoxuan Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahui Zhang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Hui Mao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Changlin Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lulu Qin
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuanqi Zhao
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Min Zhao
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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12
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Pavan A, Fasano A, Cortellini L, Lattanzi S, Papadopoulou D, Insalaco S, Germanotta M, Aprile I. Implementation of a robot-mediated upper limb rehabilitation protocol for a customized treatment after stroke: A retrospective analysis. NeuroRehabilitation 2024; 54:411-420. [PMID: 38457161 DOI: 10.3233/nre-230367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Many authors have emphasized the need for individualized treatments in rehabilitation, but no tailored robotic rehabilitation protocol for stroke patients has been established yet. OBJECTIVE To evaluate the effectiveness of a robot-mediated upper limb rehabilitation protocol based on clinical assessment for customized treatment of stroke patients. METHODS Clinical data from 81 patients with subacute stroke, undergoing an upper limb robot-mediated rehabilitation, were analyzed retrospectively. 49 patients were treated using a customized robotic protocol (experimental group, EG) based on a clinically guided flowchart, while 32 were treated without it (control group, CG). Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Motricity Index (MI), modified Barthel Index (mBI) and Numerical Rating Scale (NRS) measured before (T0) and after (T1) rehabilitation intervention were used as clinical outcomes. RESULTS There was statistically significant improvement in both groups in terms of FMA-UE, MI, and mBI, while no change in NRS. Intergroup analysis showed significantly greater improvement of the FMA-UE (P = 0.002) and MI (P < 0.001) in the EG, compared with the CG. CONCLUSION The implementation of our robotic protocol for customized treatment of stroke patients yielded greater recovery in upper limb motor function and strength over robotic treatment without a defined protocol.
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Affiliation(s)
- Arianna Pavan
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Alessio Fasano
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | | | | | | | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
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13
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Delva M, Skoryk K, Delva I. Predictors of neuropathic dysesthetic pain occurrence and chronification in multiple sclerosis (2-year prospective study). ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023229. [PMID: 38054686 PMCID: PMC10734221 DOI: 10.23750/abm.v94i6.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/03/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) are a high-risk group for neuropathic pain. OBJECTIVE to investigate predictors of neuropathic dysesthetic pain (NDP) occurrence and chronification in patients with MS during a 2-year observation period. METHODS After the exclusion criteria application and signing of informed consent, we recruited in the study 241 patients among which 23 patients prematurely stopped participating in the study. During the 2-year observation period, new NDP was diagnosed on the PainDETECT questionnaire (>18). Patients with newly diagnosed NDP were examined at baseline, in 1, 3, and 6 months depending on pain duration. The socio-demographic, neuropsychological, cognitive, sleep quality, and clinical characteristics of patients were evaluated at the beginning of the study and updated at baseline examination in cases of newly diagnosed NDP. RESULTS Over a 2-year observation period, NDP occurred in 34 patients (15.6%). Out of 34 cases of newly diagnosed NDP, in 20 cases (58.9%) pain became chronic (lasting longer than 3 months). In the Cox proportional hazards multifactorial model, progressive types of MS were an independent predictor of NDP occurrence (hazard ratio 2.60; 95% confidence interval, 1.30-5.18; p=0.01). In the multifactorial logistic regression analysis, subclinical depressive disorders (according to Hospital Anxiety and Depression Scale) were identified as an independent predictor of NDP chronification (odds ratio 7.14; 95% confidence interval, 1.12-45.59; p=0.04). CONCLUSIONS In MS predictors of NDP occurrence are progressive types of MS, whereas predictors of NDP chronification are subclinical depressive disorders.
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14
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Bekircan-Kurt CE, Jahanroshan J, Tuncer A, Ergul-Ulger Z, Gunes G, Erdem-Ozdamar S, Tan E. The evaluation of small fibers in multiple sclerosis. Mult Scler Relat Disord 2023; 72:104602. [PMID: 36889099 DOI: 10.1016/j.msard.2023.104602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 02/14/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Dysesthetic or ongoing extremity pain is a common symptom in all multiple sclerosis (MS) types. Although the pathology of the disease is the demyelination of central neurons, the patients may also complain of neuropathic pain in distal extremities that is generally related to A-delta and C fiber dysfunction. It is not known whether thinly myelinated and unmyelinated fibers are affected in MS patients. We aim to investigate the small fiber loss and its length dependency. METHODS We evaluated the skin biopsy taken from proximal and distal leg of MS patients with neuropathic pain. Six patients with primary progressive MS (PPMS), seven with relapsing-remitting MS (RRMS), seven with secondary progressive MS (SPMS) and as a control group ten age and sex-matched healthy controls were included. Neurological examination, electrophysiological evaluation and DN4 questionnaire were performed. Subsequently, skin punch biopsy from 10 cm above the lateral malleolus and proximal thigh were done. The biopsy samples were stained with PGP9.5 antibody and intraepidermal nerve fiber density (IENFD) was determined. RESULTS The mean proximal IENFD was 8.58±3.58 fibers/mm among MS patients and 14.72±2.89 fiber/mm among healthy controls (p=0.001). However, the mean distal IENFD did not differ between MS patients and healthy controls (9.26±3.24 and 9.75±1.6 fiber/mm respectively. Although proximal and distal IENFD tends to be lower in MS patients with neuropathic pain, there was no statistically significant difference between MS patients with and without neuropathic pain CONCLUSION: Although MS is a demyelinating disease, unmyelinated fibers can also be affected. Our findings suggest non-length dependent small fiber neuropathy in MS patients.
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Affiliation(s)
- Can Ebru Bekircan-Kurt
- Department of Neurology, Hacettepe University School of Medicine, Ankara, Turkey; Neuromuscular Diseases Research Laboratory, Hacettepe University School of Medicine, Ankara, Turkey.
| | - Javid Jahanroshan
- Department of Neurology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Asli Tuncer
- Department of Neurology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Zeynep Ergul-Ulger
- Department of Neurology, Hacettepe University School of Medicine, Ankara, Turkey; Neuromuscular Diseases Research Laboratory, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gursel Gunes
- Department of Hematology, University of Health Sciences Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey
| | - Sevim Erdem-Ozdamar
- Department of Neurology, Hacettepe University School of Medicine, Ankara, Turkey; Neuromuscular Diseases Research Laboratory, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ersin Tan
- Department of Neurology, Hacettepe University School of Medicine, Ankara, Turkey; Neuromuscular Diseases Research Laboratory, Hacettepe University School of Medicine, Ankara, Turkey
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15
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Kasap Z, Uğurlu H. Pain in patients with multiple sclerosis. Turk J Phys Med Rehabil 2023; 69:31-39. [PMID: 37200999 PMCID: PMC10186022 DOI: 10.5606/tftrd.2022.10524] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/15/2022] [Indexed: 05/20/2023] Open
Abstract
Objectives This study aims to identify the factors associated with pain and neuropathic pain (NP) in patients with multiple sclerosis (MS) and to determine the relationship between pain and NP with disability, functionality, activities of daily living, fatigue, mood, and quality of life (QoL). Patients and methods Between July 2017 and October 2017, a total of 100 adult patients with MS (18 males, 82 females; mean age: 35.3±9.9 years; range, 19 to 71 years) were included. All patients were evaluated in terms of pain and NP. Patients with and without pain, and patients with and without NP were compared in terms of sociodemographic characteristics, disease data, disability, functionality, daily living activities, fatigue severity, mood, and QoL using various scales. Results A total of 62% of the patients had pain. Pain was found to be associated with low education level (p=0.014), increased fatigue (p<0.001), depressive mood (p<0.001) and lower QoL (p<0.001). A total of 29.03% of patients with pain had NP. Patients with NP had a greater pain intensity (p<0.001) and fatigue (p=0.002) and lower QoL (p=0.011). The number of patients who received the correct treatment for their symptoms was low. Conclusion Pain and NP should be better investigated and treated by physicians, as these symptoms are common in MS and adversely affect the QoL and social relations of affected patients and reduce their productivity.
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Affiliation(s)
- Zerrin Kasap
- Department of Physical Medicine and Rehabilitation, Giresun University Faculty of Medicine, Giresun, Türkiye
| | - Hatice Uğurlu
- Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Türkiye
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16
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Murphy HM, Fetter CM, Snow NJ, Chaves AR, Downer MB, Ploughman M. Lower corticospinal excitability and greater fatigue among people with multiple sclerosis experiencing pain. Mult Scler J Exp Transl Clin 2023; 9:20552173221143398. [PMID: 36636581 PMCID: PMC9830099 DOI: 10.1177/20552173221143398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/17/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Persons with multiple sclerosis (MS) frequently report pain that negatively affects their quality of life. Evidence linking pain and corticospinal excitability in MS is sparse. We aimed to (1) examine differences in corticospinal excitability in MS participants with and without pain and (2) explore predictors of pain. Methods Sixty-four participants rated their pain severity on a visual analog scale (VAS). Transcranial magnetic stimulation (TMS) and validated clinical instruments characterized corticospinal excitability and subjective disease features like mood and fatigue. We retrieved information on participants' prescriptions and disability status from their clinical records. Results Fifty-five percent of participants reported pain that affected their daily functioning. Persons with pain had significantly greater fatigue and lower area under the excitatory motor evoked potential (MEP) recruitment curve (eREC AUC), a measure of total corticospinal excitability. After controlling for age, disability status, and pain medications, increased fatigue and decreased eREC AUC together explained 40% of the variance in pain. Discussion Pain in MS is multifactorial and relates to both greater fatigue and lesser corticospinal excitability. Future work should better characterize relationships between these outcomes to develop targeted pain interventions such as neuromodulation. Summary We examined pain in MS. Individuals with pain had higher fatigue and lower corticospinal excitability than those without pain. These outcomes significantly predicted self-reported pain.
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Affiliation(s)
- Hannah M. Murphy
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Christopher M. Fetter
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Nicholas J. Snow
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Arthur R. Chaves
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Matthew B. Downer
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada,Michelle Ploughman, Recovery
& Performance Laboratory, Faculty of Medicine, Memorial University of
Newfoundland, LA Miller Centre, 100 Forest Road, St. John's, NL, A1A1E5, Canada.
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17
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Smith KA, Piehl F, Olsson T, Alfredsson L, Hillert J, Kockum I, Stridh P, Montgomery S. Spasticity treatment patterns among people with multiple sclerosis: a Swedish cohort study. J Neurol Neurosurg Psychiatry 2022; 94:337-348. [PMID: 36539267 PMCID: PMC10176386 DOI: 10.1136/jnnp-2022-329886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spasticity is common among people with multiple sclerosis (MS), but there are few studies of spasticity treatment patterns. We aim to describe associations with spasticity treatment measured primarily by oral baclofen use. METHODS This cohort study using Swedish registers included 1826 and 3519 people with incident and prevalent MS (pwIMS, pwPMS) respectively, followed from 2005 to 2014. Cox regression assessed factors associated with new baclofen prescriptions and its discontinuation. RESULTS A total of 10% of pwIMS and 19% of pwPMS received baclofen, a drug prescribed specifically for spasticity in Sweden, of which many patients had relapsing-remitting course. Prescriptions occurred soon after MS diagnosis: pwIMS received baclofen typically within 6 months of diagnosis, and pwPMS within 3 years. Younger patients compared with older patients were three times more likely to receive baclofen with similar disability level measured using Expanded Disability Severity Scores (EDSS). Patients aged 18-44 years with EDSS 3.0-5.0 have an HR for baclofen use of 5.62 (95% CI 2.91 to 10.85) and EDSS 6+ have an HR of 15.41 (95% CI 7.07 to 33.58) compared with individuals with EDSS 0-2.5. In comparison, patients aged 45+ years with EDSS 3.0-5.0 have an HR of 2.05 (95% CI 1.10 to 3.82) and EDSS 6+ a hour 4.26 (95% CI 1.96 to 9.17). Baclofen discontinuation was high: 49% (95% CI 0.42 to 0.57) of pwIMS discontinued within 150 days of dispensation, 90% discontinued within 2 years including patients with progressive course or higher EDSS. Associations among pwPMS and sensitivity analyses including additional treatments were similar. CONCLUSIONS Younger patients with MS are more likely to receive baclofen compared with older patients with MS. High rates of baclofen discontinuation highlight the need for more tolerable and efficacious spasticity treatments and monitoring of spasticity among people with MS.
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Affiliation(s)
- Kelsi A Smith
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Fredrik Piehl
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Academic Specialist Centre, Centre of Neurology, SLSO, Stockholm, Sweden
| | - Tomas Olsson
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Academic Specialist Centre, Centre of Neurology, SLSO, Stockholm, Sweden
| | - Lars Alfredsson
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Centre of Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jan Hillert
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Kockum
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Stridh
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Orebro, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
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18
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Muacevic A, Adler JR, Somaily MY, Shawkhan RA, Almuhsini RA, Al Mater MA, Al Saleh AI, Alshabeeb MS, Alshahrani FS. The Assessment of the Prevalence and Disability Severity of Musculoskeletal Pain in Patients With Multiple Sclerosis in Saudi Arabia. Cureus 2022; 14:e32413. [PMID: 36644051 PMCID: PMC9833628 DOI: 10.7759/cureus.32413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
Background Multiple sclerosis (MS) is an autoimmune disease of the nervous system that causes chronic demyelination over time and may lead to physical disability. MS-related pain may be musculoskeletal, paroxysmal, or persistently neurogenic in nature. The most common type of pain is musculoskeletal discomfort, which is typically brought on by muscle weakening, stiffness, and generalized imbalance as the condition progresses. Pain often manifests after prolonged immobilization of muscles, tendons, and ligaments. Aim We aimed to evaluate the prevalence and severity of musculoskeletal pain (MSP) among MS patients in Saudi Arabia. Methodology A quantitative cross-sectional study was conducted. Patients with confirmed MS in Saudi Arabia were invited to participate in the study during the duration from April 2022 to May 2022. Data were collected using an electronic collection tool. The study tool was checked to ensure the content validity and clarity of the Arabic and English versions. Results A total of 360 MS patients were included. Patients' ages ranged from 18 to 65 years with a mean age of 34.9±13.2 years old. Exactly 229 (63.6%) patients were females. A total of 104 (28.9%) patients complained of relapsing-remitting MS, 34 (9.4%) complained of primary progressive MS, and 16 (4.4%) complained of secondary progressive MS. A total of 138 (38.3%) patients had the disease for less than five years, and 14 (3.9%) had the disease for more than 21 years. Exactly 124 (34.4%) MS patients complained of high disability due to MSP, while 236 (65.6%) had low disability. Conclusions This study demonstrates that one out of each three patients with MS complained of pain with high disability associated with pain. Old age, comorbidities, long disease duration, and a family history of MS were significant determinants of associated disability severity.
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19
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Central Neuropathic Pain Syndromes: Current and Emerging Pharmacological Strategies. CNS Drugs 2022; 36:483-516. [PMID: 35513603 DOI: 10.1007/s40263-022-00914-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 12/31/2022]
Abstract
Central neuropathic pain is caused by a disease or lesion of the brain or spinal cord. It is difficult to predict which patients will develop central pain syndromes after a central nervous system injury, but depending on the etiology, lifetime prevalence may be greater than 50%. The resulting pain is often highly distressing and difficult to treat, with no specific treatment guidelines currently available. This narrative review discusses mechanisms contributing to central neuropathic pain, and focuses on pharmacological approaches for managing common central neuropathic pain conditions such as central post-stroke pain, spinal cord injury-related pain, and multiple sclerosis-related neuropathic pain. Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and gabapentinoids have some evidence for efficacy in central neuropathic pain. Medications from other pharmacologic classes may also provide pain relief, but current evidence is limited. Certain non-pharmacologic approaches, neuromodulation in particular, may be helpful in refractory cases. Emerging data suggest that modulating the primary afferent input may open new horizons for the treatment of central neuropathic pain. For most patients, effective treatment will likely require a multimodal therapy approach.
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20
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Rivel M, Achiron A, Dolev M, Stern Y, Zeilig G, Defrin R. Unique features of central neuropathic pain in multiple sclerosis: Results of a cluster analysis. Eur J Pain 2022; 26:1107-1122. [PMID: 35263811 PMCID: PMC9313873 DOI: 10.1002/ejp.1934] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/23/2022] [Accepted: 03/06/2022] [Indexed: 11/25/2022]
Abstract
Background Central neuropathic pain (CNP) is an excruciating condition, prevalent in up to a third of patients with multiple sclerosis (MS). Identifying CNP among MS patients is particularly challenging considering the ample comorbid chronic pain conditions and sensory disturbances entailed by the disease. The aim was to identify sensory features unique to CNP beyond those of chronic pain and MS. Methods Participants were 112 MS patients: 44 with a diagnosis of CNP, 28 with a diagnosis of chronic musculoskeletal pain (MSP), and 40 pain free. Participants underwent testing of thermal and mechanical thresholds, thermal grill illusion (TGI), pain adaptation (PA), and offset analgesia (OA), and chronic pain was characterized. A two‐step cluster analysis was performed, and the association between the cluster membership and the clinical group membership (CNP, MSP, pain free) was evaluated. Results The CNP and MSP groups were similar in most of the chronic pain variables (e.g., severity, location and quality) and MS‐related variables (e.g., type, severity and medication intake). The three created clusters had unique sensory features: (1) ‘Hyposensitivity’ (increased thermal and touch thresholds) characterized the CNP group; (2) ‘Poor inhibition and hyperalgesia’ (worst PA and OA and decreased TGI threshold) characterized the MSP group; and (3) ‘Efficient inhibition’ (best PA and OA, smallest sensory loss) characterized the pain‐free group. Conclusions The unique sensory features of CNP and MSP provide insight into their pathophysiology, and evaluating them may increase the ability to provide individually based interventions. Efficient inhibition may protect MS patients from chronic pain. Significance Cluster analysis among patients with multiple sclerosis (MS) revealed that while central neuropathic pain is associated with thermal and mechanical hypoesthesia, musculoskeletal pain is involved with reduced pain inhibition and hyperalgesia; sensory profiles that provide insights into the mechanisms of these conditions and may promote an individually based pain management.
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Affiliation(s)
- Michal Rivel
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University.,Sagol School of Neuroscience, Tel Aviv University
| | - Anat Achiron
- Sagol School of Neuroscience, Tel Aviv University.,Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer.,Sackler Faculty of Medicine, Tel Aviv University
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer
| | - Yael Stern
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer
| | - Gabi Zeilig
- Sackler Faculty of Medicine, Tel Aviv University.,Department of Neurological Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University.,Sagol School of Neuroscience, Tel Aviv University
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21
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Racke MK, Frohman EM, Frohman T. Pain in Multiple Sclerosis: Understanding Pathophysiology, Diagnosis, and Management Through Clinical Vignettes. Front Neurol 2022; 12:799698. [PMID: 35095742 PMCID: PMC8794582 DOI: 10.3389/fneur.2021.799698] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Michael K Racke
- Department of Medical Affairs, Quest Diagnostics, Secaucus, NJ, United States
| | - Elliot M Frohman
- Neuroimmunology Laboratory of Lawrence Steinman, Stanford University School of Medicine, Stanford, CA, United States
| | - Teresa Frohman
- Neuroimmunology Laboratory of Lawrence Steinman, Stanford University School of Medicine, Stanford, CA, United States
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22
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Mirabelli E, Elkabes S. Neuropathic Pain in Multiple Sclerosis and Its Animal Models: Focus on Mechanisms, Knowledge Gaps and Future Directions. Front Neurol 2022; 12:793745. [PMID: 34975739 PMCID: PMC8716468 DOI: 10.3389/fneur.2021.793745] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/17/2021] [Indexed: 12/22/2022] Open
Abstract
Multiple sclerosis (MS) is a multifaceted, complex and chronic neurological disease that leads to motor, sensory and cognitive deficits. MS symptoms are unpredictable and exceedingly variable. Pain is a frequent symptom of MS and manifests as nociceptive or neuropathic pain, even at early disease stages. Neuropathic pain is one of the most debilitating symptoms that reduces quality of life and interferes with daily activities, particularly because conventional pharmacotherapies do not adequately alleviate neuropathic pain. Despite advances, the mechanisms underlying neuropathic pain in MS remain elusive. The majority of the studies investigating the pathophysiology of MS-associated neuropathic pain have been performed in animal models that replicate some of the clinical and neuropathological features of MS. Experimental autoimmune encephalomyelitis (EAE) is one of the best-characterized and most commonly used animal models of MS. As in the case of individuals with MS, rodents affected by EAE manifest increased sensitivity to pain which can be assessed by well-established assays. Investigations on EAE provided valuable insights into the pathophysiology of neuropathic pain. Nevertheless, additional investigations are warranted to better understand the events that lead to the onset and maintenance of neuropathic pain in order to identify targets that can facilitate the development of more effective therapeutic interventions. The goal of the present review is to provide an overview of several mechanisms implicated in neuropathic pain in EAE by summarizing published reports. We discuss current knowledge gaps and future research directions, especially based on information obtained by use of other animal models of neuropathic pain such as nerve injury.
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Affiliation(s)
- Ersilia Mirabelli
- Reynolds Family Spine Laboratory, Department of Neurosurgery, New Jersey Medical School, Rutgers the State University of New Jersey, Newark, NJ, United States.,Department of Biology and Chemistry, School of Health Sciences, Liberty University, Lynchburg, VA, United States
| | - Stella Elkabes
- Reynolds Family Spine Laboratory, Department of Neurosurgery, New Jersey Medical School, Rutgers the State University of New Jersey, Newark, NJ, United States
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23
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Spirin N, Kiselev D, Baranova N, Karpova M. Nociceptive and mixed pains in patients with multiple sclerosis. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:44-51. [DOI: 10.17116/jnevro202212207244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Yang X, Li X, Lai M, Wang J, Tan S, Chan HHL. Pain Symptoms in Optic Neuritis. FRONTIERS IN PAIN RESEARCH 2022; 3:865032. [PMID: 35498555 PMCID: PMC9046587 DOI: 10.3389/fpain.2022.865032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/21/2022] [Indexed: 02/05/2023] Open
Abstract
Signs and symptoms of optic neuritis (ON), an autoimmune disorder of the central nervous system (CNS), differ between patients. Pain, which is commonly reported by ON patients, may be the major reason for some patients to visit the clinic. This article reviews the presence of pain related to ON with respect to underlying disorders, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein associated disease (MOGAD). The aim of this review is to provide an overview of pain symptoms in accordance with the context of various pathophysiological explanations, assist in differential diagnosis of ON patients, especially at the onset of disease, and make recommendations to aid physicians make decisions for follow up diagnostic examinations.
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Affiliation(s)
- Xiayin Yang
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology, The First Affiliated Hospital of the Medical College of Shantou University, Shantou, China
| | - Xuefen Li
- Department of Vascular Neurosurgery, The First Affiliated Hospital of the Medical College of Shantou University, Shantou, China
- Shantou University Medical College, Guangdong, China
| | - Mengying Lai
- Shantou University Medical College, Guangdong, China
- Department of Ophthalmology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jincui Wang
- Shantou University Medical College, Guangdong, China
| | - Shaoying Tan
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Center for Eye and Vision Research (CEVR), Hong Kong, Hong Kong SAR, China
- *Correspondence: Shaoying Tan
| | - Henry Ho-lung Chan
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Center for Eye and Vision Research (CEVR), Hong Kong, Hong Kong SAR, China
- University Research Facilities in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Henry Ho-lung Chan
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25
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Malhotra A, Weaver J. Approach to Neuropathic Pain. Semin Neurol 2021; 41:744-759. [PMID: 34826876 DOI: 10.1055/s-0041-1726361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neuropathic pain is a common chief complaint encountered by neurologists and primary care providers. It is caused by disorders involving the somatosensory nervous system. The clinical evaluation of neuropathic pain is challenging and requires a multifaceted systematic approach with an emphasis on a thorough history and physical examination to identify characteristic signs and symptoms. Ancillary laboratory investigations, targeted imaging, and electrodiagnostic studies further help identify underlying etiologies to guide specific treatments. Management of neuropathic pain encompasses treating the underlying pathology as well as symptomatic control with nonpharmacological, pharmacological, and interventional therapies. Here, we present an approach to help evaluate patients with neuropathic pain.
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Affiliation(s)
- Ashwin Malhotra
- Department of Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.,Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joshua Weaver
- Department of Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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26
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Spirin NN, Kiselev DV, Karpova MS. [Neuropathic pain syndromes in patients with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:22-30. [PMID: 34387442 DOI: 10.17116/jnevro202112107222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Among the numerous pain syndromes (PS) of various localizations and types, observed in patients with multiple sclerosis (MS), the greatest attention of researchers is attracted by neuropathic PS. Neuropathic PS are often present already in the early stage of MS, significantly reduce the quality of life, hinder the social adaptation of patients, poorly respond to therapy. Central neuropathic PS, which pathogenesis is closely related with plaques in the central nervous system, are most common in patients with MS. Diagnostics of neuropathic PS in MS is based mainly on typical clinical symptoms; MRI and neurophysiological methods data are of secondary importance. This review focuses on modern concepts of three main neuropathic PS in MS: ongoing extremity pain, trigeminal neuralgia and Lhermitte's sign. Clinical symptoms of neuropathic PS, current ideas about their pathogenetic mechanisms, MRI and neurophysiological techniques data and the existing approaches to conservative therapy and surgical treatment based on randomized trials data are presented.
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Affiliation(s)
- N N Spirin
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - D V Kiselev
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - M S Karpova
- Yaroslavl State Medical University, Yaroslavl, Russia
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27
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Izquierdo C, Martín-Martínez M, Gómez-Monterrey I, González-Muñiz R. TRPM8 Channels: Advances in Structural Studies and Pharmacological Modulation. Int J Mol Sci 2021; 22:ijms22168502. [PMID: 34445208 PMCID: PMC8395166 DOI: 10.3390/ijms22168502] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022] Open
Abstract
The transient receptor potential melastatin subtype 8 (TRPM8) is a cold sensor in humans, activated by low temperatures (>10, <28 °C), but also a polymodal ion channel, stimulated by voltage, pressure, cooling compounds (menthol, icilin), and hyperosmolarity. An increased number of experimental results indicate the implication of TRPM8 channels in cold thermal transduction and pain detection, transmission, and maintenance in different tissues and organs. These channels also have a repercussion on different kinds of life-threatening tumors and other pathologies, which include urinary and respiratory tract dysfunctions, dry eye disease, and obesity. This compendium firstly covers newly described papers on the expression of TRPM8 channels and their correlation with pathological states. An overview on the structural knowledge, after cryo-electron microscopy success in solving different TRPM8 structures, as well as some insights obtained from mutagenesis studies, will follow. Most recently described families of TRPM8 modulators are also covered, along with a section of molecules that have reached clinical trials. To finalize, authors provide an outline of the potential prospects in the TRPM8 field.
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Affiliation(s)
- Carolina Izquierdo
- Departamento de Biomiméticos, Instituto de Química Médica, Juan de la Cierva 3, 28006 Madrid, Spain; (C.I.); (M.M.-M.)
- Programa de Doctorado en Química Orgánica, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Mercedes Martín-Martínez
- Departamento de Biomiméticos, Instituto de Química Médica, Juan de la Cierva 3, 28006 Madrid, Spain; (C.I.); (M.M.-M.)
| | - Isabel Gómez-Monterrey
- Dipartimento di Farmacia, Università degli Studi di Napoli “Federico II”, Via D. Montesano 49, 80131 Naples, Italy
- Correspondence: (I.G.-M.); (R.G.-M.)
| | - Rosario González-Muñiz
- Departamento de Biomiméticos, Instituto de Química Médica, Juan de la Cierva 3, 28006 Madrid, Spain; (C.I.); (M.M.-M.)
- Correspondence: (I.G.-M.); (R.G.-M.)
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28
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Vahideh Mirzaei, Eidi A, Manaheji H, Oryan S, Zaringhalam J. β-Hydroxybutyrate Attenuates Clinical Symptoms and Pain Behaviors in MOG-Induced Encephalomyelitis. NEUROCHEM J+ 2021. [DOI: 10.1134/s1819712421020100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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29
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Pellkofer HL, Kümpfel T. [Pain in multiple sclerosis and neuromyelitis optica spectrum disorders]. Schmerz 2021; 35:211-222. [PMID: 34032887 DOI: 10.1007/s00482-021-00554-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 12/15/2022]
Abstract
Multiple sclerosis and neuromyelitis optica spectrum disorders are autoimmune inflammatory diseases of the central nervous system, which can lead to a multitude of neurological complaints and pain syndromes. Pain may be an acute symptom during disease exacerbation as well as a chronic symptom, whereby the latter sometimes substantially reduces the quality of life. The etiology of pain is very heterogeneous but the rapid differential diagnostic classification is decisive in order to be able to initiate a differentiated treatment strategy. Chronic pain must be differentiated from pain as a possible (early) symptom of an acute disease exacerbation, classified in more detail and individually treated. These include central neuropathic pain, pain associated with spasticity, musculoskeletal pain due to excess loading and pain as a side effect of immunotherapy and in the context of comorbidities. The treatment strategies are often insufficiently evidence-based due to the lack of data.
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Affiliation(s)
- Hannah L Pellkofer
- Institut für Klinische Neuroimmunologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
| | - Tania Kümpfel
- Institut für Klinische Neuroimmunologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
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30
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Knowles LM, Phillips KM, Herring TE, Alschuler KN, Jensen MP, Turner AP, Ehde DM. Pain Intensity and Pain Interference in People With Progressive Multiple Sclerosis Compared With People With Relapsing-Remitting Multiple Sclerosis. Arch Phys Med Rehabil 2021; 102:1959-1964. [PMID: 34048792 DOI: 10.1016/j.apmr.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe pain intensity and interference in people with progressive multiple sclerosis (MS), compare these with people with relapsing-remitting multiple sclerosis (RRMS), and identify common and unique factors associated with pain intensity in people with progressive MS and RRMS. DESIGN Observational, cross-sectional analysis using baseline data from a longitudinal survey on quality of life in participants with MS. SETTING Community. PARTICIPANTS A total of 573 adults with MS (N=573; progressive MS, n=142; RRMS, n=431). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Average pain intensity was measured by an 11-point numeric rating scale, and pain interference was measured by the Patient-Reported Outcomes Measurement Information System Pain Interference Short Form. RESULTS Participants with progressive MS reported moderate average pain intensity (3.22±2.50) and elevated pain interference (T score of 55.55±9.13). They did not differ significantly from those with RRMS in average pain intensity or pain interference. Common factors associated with higher average pain intensity were more severe disability, lower education level, unemployment, and current smoking. In those with progressive MS, older age was associated with lower average pain intensity. CONCLUSIONS Pain intensity and interference are similar across MS types. In addition to assessing and treating pain, it is important to screen for modifiable pain-related factors, such as smoking cessation, in this population.
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Affiliation(s)
- Lindsey M Knowles
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Multiple Sclerosis Center of Excellence-West, Veterans Administration Puget Sound Health Care System, Seattle Division, Seattle, WA.
| | - Kala M Phillips
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Tracy E Herring
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Department of Neurology, University of Washington School of Medicine, Seattle, WA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Aaron P Turner
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Multiple Sclerosis Center of Excellence-West, Veterans Administration Puget Sound Health Care System, Seattle Division, Seattle, WA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
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31
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Neural substrates for poststroke complex regional pain syndrome type I: a retrospective case-control study using voxel-based lesion symptom mapping analysis. Pain 2021; 161:1311-1320. [PMID: 31985589 DOI: 10.1097/j.pain.0000000000001816] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Poststroke complex regional pain syndrome (CRPS) is characterized by swelling, pain, and changes in the skin that appear on the affected wrist and hand. In this retrospective study, we analyzed the relationship between poststroke CRPS and the location of stroke lesion. From all patients admitted to our hospital from 2009 to 2019, we recruited 80 patients affected by their first unilateral stroke who met the inclusion/exclusion criteria. Thirty-eight patients diagnosed with CRPS after stroke were assigned to the experimental group according to the "Budapest criteria" adopted by the International Association for the Study of Pain, and 42 patients without CRPS were included as controls. Regions of interest were manually drawn on T1-weighted magnetic resonance images, and data were normalized to a standard brain template. In the poststroke CRPS group, the relationship between the location of brain lesion and pain severity was analyzed using Freedman-Lane multivariable regression adjusting for Medication Quantification Scale rating, which was the only parameter to show a statistically significant correlation with pain intensity. A threshold of P < 0.01 was considered statistically significant for all voxel-based lesion symptom mapping tests, corrected for multiple comparisons with 5000 permutations. Analyses using voxel-wise subtraction and Liebermeister statistics indicated that the corticospinal tract (CST) was associated with the development of poststroke CRPS. Statistically significant correlations were found between pain intensity and the CST and the adjacent lentiform nucleus. Our results suggest that the CST may be a relevant neural structure for development of poststroke CRPS and the intensity of pain caused by the syndrome.
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32
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Kratz AL, Whibley D, Alschuler KN, Ehde DM, Williams DA, Clauw DJ, Braley TJ. Characterizing chronic pain phenotypes in multiple sclerosis: a nationwide survey study. Pain 2021; 162:1426-1433. [PMID: 33196577 PMCID: PMC8054538 DOI: 10.1097/j.pain.0000000000002136] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
ABSTRACT Chronic pain is highly prevalent in multiple sclerosis (MS). Pain heterogeneity may contribute to poor treatment outcomes. The aim of this study was to characterize pain phenotypes distributions in persons with MS and compare pain phenotypes in terms of pain intensity, frequency of chronic overlapping pain conditions, and use and analgesic effects of different classes of pain medications. Data were collected through a national web-based survey with measures of neuropathic (painDETECT) and nociplastic pain (Fibromyalgia Survey Criteria), chronic overlapping pain conditions, and pain medication use and pain relief. In a sample of N = 842 adults with chronic pain and MS, the largest proportion (41%) showed evidence of nociceptive pain, 27% had mixed neuropathic/nociplastic pain, 23% had nociplastic pain, and 9% had neuropathic pain. Nociplastic pain was associated with significantly higher pain intensity and frequency of chronic overlapping pain conditions. Across all pain types, high frequency of pain medication use along with poor-modest pain relief was reported. Cannabis use for pain was more common, and pain relief ratings were higher among those with nociplastic pain, relative to nociceptive pain. Although NSAID use was highest among those with nociplastic pain (80%), pain relief ratings for NSAIDs were highest among those with nociceptive pain. These findings underscore the need for multidimensional assessment of pain in MS with greater emphasis on the identification of pain phenotype. An improved characterization of pain as a multifaceted condition in MS could inform therapeutic approaches.
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Affiliation(s)
- Anna L. Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Kevin N. Alschuler
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- Department of Neurology, University of Washington, Seattle, WA, United States
| | - Dawn M. Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - David A. Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Daniel J. Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Tiffany J. Braley
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
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33
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Longitudinal prevalence and determinants of pain in multiple sclerosis: results from the German National Multiple Sclerosis Cohort study. Pain 2021; 161:787-796. [PMID: 32197038 DOI: 10.1097/j.pain.0000000000001767] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pain is frequent in multiple sclerosis (MS) and includes different types, with neuropathic pain (NP) being most closely related to MS pathology. However, prevalence estimates vary largely, and causal relationships between pain and biopsychosocial factors in MS are largely unknown. Longitudinal studies might help to clarify the prevalence and determinants of pain in MS. To this end, we analyzed data from 410 patients with newly diagnosed clinically isolated syndrome or relapsing-remitting MS participating in the prospective multicenter German National MS Cohort Study (NationMS) at baseline and after 4 years. Pain was assessed by self-report using the PainDETECT Questionnaire. Neuropsychiatric assessment included tests for fatigue, depression, and cognition. In addition, sociodemographic and clinical data were obtained. Prevalence of pain of any type was 40% and 36% at baseline and after 4 years, respectively, whereas prevalence of NP was 2% and 5%. Pain of any type and NP were both strongly linked to fatigue, depression, and disability. This link was even stronger after 4 years than at baseline. Moreover, changes in pain, depression, and fatigue were highly correlated without any of these symptoms preceding the others. Taken together, pain of any type seems to be much more frequent than NP in early nonprogressive MS. Moreover, the close relationship between pain, fatigue, and depression in MS should be considered for treatment decisions and future research on a possible common pathophysiology.
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34
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Shraim MA, Massé-Alarie H, Hodges PW. Methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a systematic review. Pain 2021; 162:1007-1037. [PMID: 33136983 DOI: 10.1097/j.pain.0000000000002113] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022]
Abstract
ABSTRACT Mechanism-based classification of pain has been advocated widely to aid tailoring of interventions for individuals experiencing persistent musculoskeletal pain. Three pain mechanism categories (PMCs) are defined by the International Association for the Study of Pain: nociceptive, neuropathic, and nociplastic pain. Discrimination between them remains challenging. This study aimed to build on a framework developed to converge the diverse literature of PMCs to systematically review methods purported to discriminate between them; synthesise and thematically analyse these methods to identify the convergence and divergence of opinion; and report validation, psychometric properties, and strengths/weaknesses of these methods. The search strategy identified articles discussing methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system. Studies that assessed the validity of methods to discriminate between categories were assessed for quality. Extraction and thematic analysis were undertaken on 184 articles. Data synthesis identified 200 methods in 5 themes: clinical examination, quantitative sensory testing, imaging, diagnostic and laboratory testing, and pain-type questionnaires. Few methods have been validated for discrimination between PMCs. There was general convergence but some disagreement regarding findings that discriminate between PMCs. A combination of features and methods, rather than a single method, was generally recommended to discriminate between PMCs. Two major limitations were identified: an overlap of findings of methods between categories due to mixed presentations and many methods considered discrimination between 2 PMCs but not others. The results of this review provide a foundation to refine methods to differentiate mechanisms for musculoskeletal pain.
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Affiliation(s)
- Muath A Shraim
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
| | - Hugo Massé-Alarie
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
- Centre Interdisciplinaire de recherche en réadaptation et Integration sociale (CIRRIS), Université Laval, Québec, QC, Canada
| | - Paul W Hodges
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
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35
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Rivel M, Achiron A, Dolev M, Stern Y, Zeilig G, Defrin R. Central neuropathic pain in multiple sclerosis is associated with impaired innocuous thermal pathways and neuronal hyperexcitability. PAIN MEDICINE 2021; 22:2311-2323. [PMID: 33734398 DOI: 10.1093/pm/pnab103] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE About a third of patients with multiple sclerosis (MS) suffer from chronic and excruciating central neuropathic pain (CNP). The mechanism underlying CNP in MS is not clear, since previous studies are scarce and their results are inconsistent. Our aim was to determine whether CNP in MS is associated with impairment of the spinothalamic-thalamocortical pathways (STTCs) and/or increased excitability of the pain system. DESIGN Cross sectional study. SETTING General hospital. SUBJECTS 47 MS patients with CNP, 42 MS patients without CNP, and 32 healthy controls. METHODS Sensory testing included the measurement of temperature, pain, and touch thresholds and the thermal grill illusion (TGI) for evaluating STTCs function, and hyperpathia and allodynia as indicators of hyperexcitability. CNP was characterized using interviews and questionnaires. RESULTS The CNP group had higher cold and warm thresholds (p < 0.01), as well as higher TGI perception thresholds (p < 0.05), especially in painful body regions compared to controls, whereas touch and pain thresholds values were normal. The CNP group also had a significantly greater prevalence of hyperpathia and allodynia. Regression analysis revealed that whereas presence of CNP was associated with a higher cold threshold, CNP intensity, and the number of painful body regions were associated with allodynia and hyperpathia, respectively. CONCLUSIONS CNP in MS is characterized by a specific impairment of STTC function; the innocuous thermal pathways, and by pain hyperexcitability. Whereas CNP presence is associated with STTC impairment, its severity and extent are associated with pain hyperexcitability. Interventions that reduce excitability level may therefore mitigate CNP severity.
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Affiliation(s)
- Michal Rivel
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine Tel Aviv University.,Sagol School of Neuroscience, Tel-Aviv University
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer
| | - Yael Stern
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer
| | - Gaby Zeilig
- Sackler Faculty of Medicine, Tel-Aviv University.,Department of Neurological Rehabilitation, Sheba Medical Center, Tel Hashomer
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine Tel Aviv University.,Sagol School of Neuroscience, Tel-Aviv University
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36
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Zackowski KM, Freeman J, Brichetto G, Centonze D, Dalgas U, DeLuca J, Ehde D, Elgott S, Fanning V, Feys P, Finlayson M, Gold SM, Inglese M, Marrie RA, Ploughman M, Sang CN, Sastre-Garriga J, Sincock C, Strum J, van Beek J, Feinstein A. Prioritizing progressive MS rehabilitation research: A call from the International Progressive MS Alliance. Mult Scler 2021; 27:989-1001. [PMID: 33720795 PMCID: PMC8151585 DOI: 10.1177/1352458521999970] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: People with multiple sclerosis (MS) experience myriad symptoms that negatively affect their quality of life. Despite significant progress in rehabilitation strategies for people living with relapsing-remitting MS (RRMS), the development of similar strategies for people with progressive MS has received little attention. Objective: To highlight key symptoms of importance to people with progressive MS and stimulate the design and implementation of high-quality studies focused on symptom management and rehabilitation. Methods: A group of international research experts, representatives from industry, and people affected by progressive MS was convened by the International Progressive MS Alliance to devise research priorities for addressing symptoms in progressive MS. Results: Based on information from the MS community, we outline a rationale for highlighting four symptoms of particular interest: fatigue, mobility and upper extremity impairment, pain, and cognitive impairment. Factors such as depression, resilience, comorbidities, and psychosocial support are described, as they affect treatment efficacy. Conclusions: This coordinated call to action—to the research community to prioritize investigation of effective symptom management strategies, and to funders to support them—is an important step in addressing gaps in rehabilitation research for people affected by progressive MS.
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Affiliation(s)
- Kathleen M Zackowski
- KM Zackowski Patient Management Care and Rehabilitation Research, National Multiple Sclerosis Society, 733 3rd Avenue, 3rd floor, New York, NY 10017, USA.
| | - Jennifer Freeman
- School of Health Professions, University of Plymouth, Plymouth UK
| | | | - Diego Centonze
- Department of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ulrik Dalgas
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Department of Research, Kessler Foundation, West Orange, NJ, USA
| | - Dawn Ehde
- Department of Rehabilitation Medicine, University of Washington Medicine, Seattle, WA, USA
| | - Sara Elgott
- Global Director of Patient Affairs, MedDay Pharmaceuticals, Maidenhead, UK
| | - Vanessa Fanning
- People Affected by MS Committee, International Progressive MS Alliance, Canberra, ACT, Australia
| | - Peter Feys
- Department of Rehabilitation Sciences and Physiotherapy, Universiteit Hasselt, Hasselt, Belgium
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Stefan M Gold
- Department of Neuropsychiatry, Charitè—University of Medicine Berlin, Berlin, Germany
| | - Matilde Inglese
- Department of Neurology, Radiology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Michelle Ploughman
- Department of Physical Medicine and Rehabilitation, Memorial University of Newfoundland, St. Johns, NL, Canada
| | - Christine N Sang
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Caroline Sincock
- Scientific Steering Committee, International Progressive MS Alliance, Glasgow, UK
| | - Jonathan Strum
- Scientific Steering Committee, International Progressive MS Alliance, Long Beach, CA, USA
| | - Johan van Beek
- Global International Scientific Director, Neuroimmunology, F. Hoffmann-La Roche, Ltd., Basel, Switzerland
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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37
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Zucchella C, Mantovani E, De Icco R, Tassorelli C, Sandrini G, Tamburin S. Non-invasive Brain and Spinal Stimulation for Pain and Related Symptoms in Multiple Sclerosis: A Systematic Review. Front Neurosci 2020; 14:547069. [PMID: 33328843 PMCID: PMC7715002 DOI: 10.3389/fnins.2020.547069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Neuropathic and nociceptive pain frequently affect patients with multiple sclerosis (MS), with a prevalence close to 90% and significant impact on general health and quality of life. Pharmacological strategies are widely used to treat pain in MS, but their effectiveness and side-effects are controversial. Among non-pharmacological treatments for pain, non-invasive brain and spinal stimulation (NIBSS) has shown promising preliminary results in MS. Objective: Systematic review to investigate the effect of NIBSS for the management of pain in MS. Methods: A literature search using Pubmed, Science Direct and Web of Science was conducted from databases inception to February 21, 2020 for studies assessing the analgesic effect of NIBSS on pain in MS. Results: A total of 279 records were title- and abstract-screened, nine were assessed for full text and included. The NIBSS techniques explored were transcranial direct current stimulation (N = 5), transcranial magnetic stimulation (N = 2), transcranial random noise stimulation (N =1), transcutaneous spinal direct current stimulation (N = 1). The targets were the primary motor cortex (M1; N = 4), the left dorsolateral pre-frontal cortex (DLPFC; N = 3), the spinal cord (N = 1), unspecified brain target (N = 1). The study designs were randomized (N = 7), open label (N = 1), single case report (N = 1). Despite the differences in study design, target and NIBSS technique that impeded a meta-analysis, all the studies converge in showing a significant improvement of pain after active NIBSS with less consistent effects on other symptoms of the pain-related cluster (depression, fatigue, cognition) and quality of life. Conclusions: Excitatory NIBSS over M1, left DLPFC and spinal cord appear to be the most effective protocols for pain in MS. Open questions include the use of neurophysiological or neuroimaging surrogate outcome measures, the stratification of patients according to the clinical profiles and underlying pathogenetic mechanisms and the combination of NIBSS to pharmacological treatment, neurorehabilitation, or psychotherapy to improve the clinical effect. The duration of the effect to NIBSS and the feasibility and efficacy of telemedicine NIBSS protocols are other open key questions.
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Affiliation(s)
- Chiara Zucchella
- Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto De Icco
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giorgio Sandrini
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stefano Tamburin
- Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Hatipoglu Majernik G, Al-Afif S, Heissler HE, Krauss JK. Operative findings and outcome of microvascular decompression/adhesiolysis for trigeminal neuralgia in multiple sclerosis without demyelinating brain stem lesions. Clin Neurol Neurosurg 2020; 200:106376. [PMID: 33254046 DOI: 10.1016/j.clineuro.2020.106376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) in multiple sclerosis (MS) poses several challenges for treatment. Although these patients often have typical attacks, they may not be considered as candidates for microvascular decompression (MVD). Here we report on surgical findings and long term follow-up of MVD/ adhesiolysis in a series of patients with multiple sclerosis but without demyelinating brain stem lesions. METHODS Fifteen patients with MS-related TN underwent MVD/ adhesiolysis. Demyelinating brain stem lesions were excluded radiologically. Outcome of the intervention was assessed according to the Barrow Neurological Institute (BNI) pain intensity score at 3, 12, 24 months follow-up and at the last available follow-up (mean 88.2 months, range 38-146). RESULTS All 15 patients benefited from MVD/adhesiolysis and were pain free on the first day of surgery. Intraoperative findings included arterial contact in 7/15 (47 %) patients, venous contact in 9/15 (60 %), and prominent arachnoid thickening in 12/15 (80 %). The distribution of the BNI pain intensity scores showed marked improvement at all follow-up evaluations. Five patients underwent repeat MVD/adhesiolysis for pain recurrence at a mean of 43 months after the first surgery. Long term evaluation at the last available follow-up demonstrated favorable outcome in 13/15 patients (BNI I-IIIa) (87 %), while 2/15 patients had limited benefit (BNI IV). CONCLUSIONS MS-related TN in patients without demyelinating brain stem lesions may be related either to vascular conflicts or to focal arachnoiditis at the trigeminal nerve entry zone. MVD/ adhesiolysis may be considered as a useful treatment option in this subgroup of patients with regard to long term outcome.
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Affiliation(s)
| | - Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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Srotova I, Kocica J, Vollert J, Kolcava J, Hulova M, Jarkovsky J, Dusek L, Bednarik J, Vlckova E. Sensory and pain modulation profiles of ongoing central neuropathic extremity pain in multiple sclerosis. Eur J Pain 2020; 25:573-594. [PMID: 33170994 DOI: 10.1002/ejp.1695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/24/2020] [Accepted: 11/06/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Central neuropathic extremity pain (CNEP) is the most frequent type of pain in multiple sclerosis (MS). The aim of the present study was to evaluate sensory and pain modulation profiles in MS patients with CNEP. METHODS In a single-centre observational study, a group of 56 CNEP MS patients was compared with 63 pain-free MS patients and with a sex- and age-adjusted control group. Standardized quantitative sensory testing (QST) and dynamic QST (dQST) protocols comprising temporal summation and conditioned pain modulation tests were used to compare sensory profiles. RESULTS Loss-type QST abnormalities in both thermal and mechanical QST modalities prevailed in both MS subgroups and correlated significantly with higher degree of disability expressed as Expanded Disability Status Scale (EDSS). Comparison of sensory phenotypes disclosed a higher frequency of the 'sensory loss' prototypic sensory phenotype in the CNEP subgroup (30%) compared with pain-free MS patients (6%; p = .003). CONCLUSION The role of aging process and higher lesion load in the spinothalamocortical pathway might be possible explanation for pain development in this particular 'deafferentation' subtype of central neuropathic pain in MS. We were unable to support the role of central sensitization or endogenous facilitatory and inhibitory mechanisms in the development of CNEP in MS. SIGNIFICANCE This article presents higher prevalence of the 'sensory loss' prototypic sensory phenotype in multiple sclerosis patients with central extremity neuropathic pain compared to pain-free patients. Higher degree of disability underlines the possible role of higher lesion load in the somatosensory pathways in this particular 'deafferentation' type of central neuropathic pain.
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Affiliation(s)
- Iva Srotova
- Department of Neurology, University Hospital Brno, Brno, Czech Republic
| | - Jan Kocica
- Department of Neurology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Vollert
- Pain Research, Faculty of Medicine, Department of Surgery & Cancer, Chelsea and Westminster Campus, Imperial College London, London, UK.,Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
| | - Jan Kolcava
- Department of Neurology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Monika Hulova
- Department of Neurology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiří Jarkovsky
- Institute for Biostatistics and Analyses, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Ladislav Dusek
- Institute for Biostatistics and Analyses, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Eva Vlckova
- Department of Neurology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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40
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Tutuncu M, Ertem DH, Soysal A. Prevalence And Impact Of Myofascial Pain Syndrome In Relapsing-Remitting Multiple Sclerosis And The Effects Of Local Anesthetic Injections For Short-Term Treatment. Mult Scler Relat Disord 2020; 46:102528. [PMID: 33022587 DOI: 10.1016/j.msard.2020.102528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/13/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies have suggested that patients with multiple sclerosis (MS) who have comorbid musculoskeletal disorders have a lower quality of life. However, there is limited data on the relationship between myofascial pain syndromes (MFPS) and MS. The aim of the study to investigate the frequency and impact of MFPS in patients with MS, to evaluate the effect of local anesthetic injections for short-term treatment. METHOD Three hundred ninety-eight patients with MS patients were evaluated during the study period. Patients meeting the inclusion criteria investigated for MFPS. Patients with active myofascial trigger points received local anesthetics blocks monthly and attended at least 4 follow-up appointments. Multiple Sclerosis Quality of Life Instrument 54 (MSQO-54), Beck Depression Scale, The Numeric Pain Rating Scale (NPRS), Fatigue Severity Scale, and Fatigue Impact Scale were administered before and after injections. The primary outcome was a 50 % reduction in pain intensity. RESULTS One hundred thirty-seven patients with relapsing remitting MS (RRMS) met the inclusion criteria. MFPS was present in 70 of 137 (51.9 %) patients. Thirty-one patients participated; however, 25 patients completed the study. From 3-months post injections, a significant decrease in NPRS was found (p<0.001); in addition, the scores of MSQO-54 have significantly increased and the scores of fatigue impact and severity tests were decreased (p<0.001). No serious complications were noted. CONCLUSION The results of this study support that MFPS can be experienced in patients with RRMS. Local anesthetic injections for trigger points may be an effective, tolerable, and inexpensive treatment for this patient group and contribute to significant reductions in pain severity scores and increase the quality of life.
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Affiliation(s)
- Mesude Tutuncu
- University Of Health Sciences İstanbul Bakırköy Prof. Dr. Mazhar Osman Psychıatrıc Traınıng And Research Hospıtal, Department of Neurology, Istanbul, Turkey.
| | - Devrimsel Harika Ertem
- University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Department of Pain Management, Istanbul, Turkey.
| | - Aysun Soysal
- University Of Health Sciences İstanbul Bakırköy Prof. Dr. Mazhar Osman Psychıatrıc Traınıng And Research Hospıtal, Department of Neurology, Istanbul, Turkey.
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41
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Plantone D, Vollono C, Pardini M, Primiano G, Myftari V, Vitetta F, Sola P, Mirabella M, Ferraro D. A voxel-based lesion symptom mapping analysis of chronic pain in multiple sclerosis. Neurol Sci 2020; 42:1941-1947. [PMID: 32975673 DOI: 10.1007/s10072-020-04745-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 09/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pain is one of the most disabling symptoms in multiple sclerosis. Chronic pain in multiple sclerosis is often neuropathic in nature, although a clear-cut distinction with nociceptive pain is not easy. OBJECTIVE The aim of our study was to analyze the MRIs of multiple sclerosis patients with chronic pain in order to explore possible associations with lesion sites, on a voxel-by-voxel basis. MATERIALS AND METHODS We enrolled patients aged > 18 years with multiple sclerosis in accordance with the 2010 McDonald criteria. Patients meeting criteria for persistent pain (frequent or constant pain lasting > 3 months) were included in the "pain group". The other patients were included in the "no pain group". We outlined lesions on FLAIR MRI scans using a semi-automated edge finding tool. To detect the association between lesion localization and persistent pain, images were analysed with the voxel-based lesion symptom mapping methods implemented in the (nonparametric mapping software included into the MRIcron. RESULTS We enrolled 208 MS patients (140 F, mean age 55.2 ± 9.4 years; 176 RR, 28 progressive MS; mean EDSS 2.0 + 2.0). Pain group included 96 patients and no pain group 112 patients. Lesions of the right dorsolateral prefrontal area were significantly more prevalent in patients without pain, whereas periventricular posterior lesions were significantly more prevalent in patients with persistent pain. CONCLUSION Our data suggest a role of the right dorsolateral prefrontal cortex in the modulation of pain perception and in the occurrence of chronic pain in MS patients. Our data also support a hemispheric asymmetry in pain perception and modulation.
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Affiliation(s)
- Domenico Plantone
- Neurology Unit, Di Venere Hospital-ASL Bari, Via Ospedale Di Venere, 1, 70131, Bari, Italy.
| | - Catello Vollono
- Neurology Institute, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Guido Primiano
- Neurology Institute, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Virxhina Myftari
- Department of Biomedical Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Vitetta
- Neurology Unit, Ospedale Civile, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Patrizia Sola
- Neurology Unit, Ospedale Civile, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Massimiliano Mirabella
- Neurology Institute, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Diana Ferraro
- Department of Biomedical Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, Ospedale Civile, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
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42
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Affiliation(s)
- Giorgio Cruccu
- From the Department of Human Neuroscience, Sapienza University of Rome, Rome
| | - Giulia Di Stefano
- From the Department of Human Neuroscience, Sapienza University of Rome, Rome
| | - Andrea Truini
- From the Department of Human Neuroscience, Sapienza University of Rome, Rome
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The Effect of Kinesio Taping on Spasticity: A Randomized, Controlled, Double-Blind Pilot Study in Para-Swimmers. J Sport Rehabil 2020; 30:414-421. [PMID: 32788417 DOI: 10.1123/jsr.2019-0504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/01/2020] [Accepted: 05/24/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Kinesio Taping (KT) produces several clinical effects, including pain relief, edema absorption, and improved muscle performance. When applied in the insertion to origin mode, it is claimed to inhibit excessive muscle contractions. OBJECTIVE Investigate whether KT applied in the insertion to origin mode could reduce the exaggerated reflex contraction of spastic muscles. DESIGN Randomized crossover trial, with a restricted block randomization. SETTING Clinical laboratory and swimming pool. PATIENTS Seven para-swimmers. INTERVENTION KT, applied in inhibitory mode, to investigate its effect on knee extensor spasticity. MAIN OUTCOME MEASURES Primary outcome is stretch reflex, as compared with clinical assessment of spasticity by Modified Ashworth Scale and self-perceived spasticity by numeric rating scale. Secondary outcomes were Medical Research Council for strength of knee extensor muscles and chronometric swimming performance in 100-m freestyle. RESULTS KT significantly decreased the amplitude of stretch reflex (P < .001), whereas the placebo treatment produced no significant effects. Scores of Medical Research Council for strength and Modified Ashworth Scale did not change after KT, whereas numeric rating scale scores for spasticity significantly decreased (P = .001). The swimming performance was significantly improved after KT treatment as compared with baseline (P < .01). CONCLUSIONS This exploratory study performed on para-athletes suggests that KT could reduce spasticity. This outcome has 3-fold implications for clinical, rehabilitation, and sport methods.
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44
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Systematic Review and Synthesis of Mechanism-based Classification Systems for Pain Experienced in the Musculoskeletal System. Clin J Pain 2020; 36:793-812. [DOI: 10.1097/ajp.0000000000000860] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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45
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Abstract
Pain is a major matter for patients with multiple sclerosis; treatment response is frequently inadequate, with a significant impact on quality of life. The estimated prevalence of pain in multiple sclerosis ranges widely (26-86%), and different subtypes of pain, mediated by specific pathophysiological mechanisms, are described. The aim of this narrative review, performed using a systematic search methodology, was to provide current, evidence-based, knowledge about the pharmacological treatment of the different kinds of pain in multiple sclerosis. We searched for relevant papers within PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Clinical Trials database (ClinicalTrials.gov), considering publications up to November 2019. Two authors independently selected studies for inclusion, data extraction, and bias assessment. A total of 27 randomized controlled trials were identified, but in only a few cases, patients with different pain qualities were stratified. Following a mechanism-based approach, treatment of paroxysmal pain and painful tonic spasms should be based on sodium-channel blockers, whereas treatment of ongoing extremity pain should be based on gabapentinoids and antidepressants.
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46
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Yu S, Chen Y, Cai Q, Ma K, Zheng H, Xie L. A Novel Quantitative Spasticity Evaluation Method Based on Surface Electromyogram Signals and Adaptive Neuro Fuzzy Inference System. Front Neurosci 2020; 14:462. [PMID: 32523505 PMCID: PMC7261936 DOI: 10.3389/fnins.2020.00462] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/15/2020] [Indexed: 02/02/2023] Open
Abstract
Stroke patients often suffer from spasticity. Before treatment of spasticity, there are often practical demands for objective and quantitative assessment of muscle spasticity. However, the common quantitative spasticity assessment method, the tonic stretch reflex threshold (TSRT), is time-consuming and complicated to implement due to the requirement of multiple passive stretches. To evaluate spasticity conveniently, a novel spasticity evaluation method based on surface electromyogram (sEMG) signals and adaptive neuro fuzzy inference system (i.e., the sEMG-ANFIS method) was presented in this paper. Eleven stroke patients with spasticity and four healthy subjects were recruited to participate in the experiment. During the experiment, the Modified Ashworth scale (MAS) scores of each subject was obtained and sEMG signals from four elbow flexors or extensors were collected from several times (4–5) repetitions of passive stretching. Four time-domain features (root mean square, the zero-cross rate, the wavelength and a 4th-order autoregressive model coefficient) and one frequency-domain feature (the mean power frequency) were extracted from the collected sEMG signals to reflect the spasticity information. Using the ANFIS classifier, excellent regression performance was achieved [mean accuracy = 0.96, mean root-mean-square error (RMSE) = 0.13], outperforming the classical TSRT method (accuracy = 0.88, RMSE = 0.28). The results showed that the sEMG-ANFIS method not only has higher accuracy but also is convenient to implement by requiring fewer repetitions (4–5) of passive stretches. The sEMG-ANFIS method can help stroke patients develop proper rehabilitation training programs and can potentially be used to provide therapeutic feedback for some new spasticity interventions, such as shockwave therapy and repetitive transcranial magnetic stimulation.
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Affiliation(s)
- Song Yu
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
| | - Yan Chen
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
| | - Qing Cai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ke Ma
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou, China
| | - Haiqing Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Longhan Xie
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
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47
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Chisari CG, Sgarlata E, Arena S, D’Amico E, Toscano S, Patti F. An update on the pharmacological management of pain in patients with multiple sclerosis. Expert Opin Pharmacother 2020; 21:2249-2263. [DOI: 10.1080/14656566.2020.1757649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Clara G. Chisari
- Department “GF Ingrassia”, Section of Neurosciences, University of Catania, Catania, Italy
| | - Eleonora Sgarlata
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
- Stroke Unit, Department of Medicine, Umberto I Hospital, Siracusa, Italy
| | - Sebastiano Arena
- Department “GF Ingrassia”, Section of Neurosciences, University of Catania, Catania, Italy
| | - Emanuele D’Amico
- Department “GF Ingrassia”, Section of Neurosciences, University of Catania, Catania, Italy
| | - Simona Toscano
- Department “GF Ingrassia”, Section of Neurosciences, University of Catania, Catania, Italy
| | - Francesco Patti
- Department “GF Ingrassia”, Section of Neurosciences, University of Catania, Catania, Italy
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Rodríguez de Antonio LA, García Castañón I, Aguilar-Amat Prior MJ, Puertas I, González Suárez I, Oreja Guevara C. Non-inflammatory causes of emergency consultation in patients with multiple sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2020; 36:403-411. [PMID: 34238522 DOI: 10.1016/j.nrleng.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/26/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To describe non-relapse-related emergency consultations of patients with multiple sclerosis (MS): causes, difficulties in the diagnosis, clinical characteristics, and treatments administered. METHODS We performed a retrospective study of patients who attended a multiple sclerosis day hospital due to suspected relapse and received an alternative diagnosis, over a 2-year period. Demographic data, clinical characteristics, final diagnosis, and treatments administered were evaluated. Patients who were initially diagnosed with pseudo-relapse and ultimately diagnosed with true relapse were evaluated specifically. As an exploratory analysis, patients who consulted with non-inflammatory causes were compared with a randomly selected cohort of patients with true relapses who attended the centre in the same period. RESULTS The study included 50 patients (33 were women; mean age 41.4 ± 11.7 years). Four patients (8%) were initially diagnosed with pseudo-relapse and later diagnosed as having a true relapse. Fever and vertigo were the main confounding factors. The non-inflammatory causes of emergency consultation were: neurological, 43.5% (20 patients); infectious, 15.2% (7); psychiatric, 10.9% (5); vertigo, 8.6% (4); trauma, 10.9% (5); and miscellaneous, 10.9% (5). CONCLUSIONS MS-related symptoms constituted the most frequent cause of non-inflammatory emergency consultations. Close follow-up of relapse and pseudo-relapse is necessary to detect incorrect initial diagnoses, avoid unnecessary treatments, and relieve patients' symptoms.
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Affiliation(s)
| | - I García Castañón
- Servicio de Neurología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | | | - I Puertas
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, Spain
| | - I González Suárez
- Servicio de Neurología, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - C Oreja Guevara
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, Spain
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49
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Hochsprung A, Escudero-Uribe S, Ibáñez-Vera AJ, Izquierdo-Ayuso G. Effectiveness of monopolar dielectric transmission of pulsed electromagnetic fields for multiple sclerosis-related pain: a pilot study. NEUROLOGÍA (ENGLISH EDITION) 2020; 36:433-439. [PMID: 34238526 DOI: 10.1016/j.nrleng.2018.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/01/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Pain is highly prevalent in patients with multiple sclerosis (MS); it is chronic in 50% of cases and is classified as nociceptive, neuropathic, or mixed-type. Pain affects quality of life, sleep, and the activities of daily living. Electrotherapy is an interesting alternative or complementary treatment in the management of pain in MS, with new innovations constantly appearing. MATERIAL AND METHODS This study evaluates the effectiveness of treatment with monopolar dielectric transmission of pulsed electromagnetic fields (PEMF) for pain associated with MS. We performed a randomised, placebo-controlled clinical trial including 24 patients, who were assessed with the Brief Pain Inventory, the Multiple Sclerosis International Quality of Life questionnaire, the Beck Depression Inventory, and the Modified Fatigue Impact Scale. RESULTS Statistically significant improvements were observed in maximum and mean pain scores, as well as in the impact of pain on work, personal relationships, and sleep and rest. Not significant differences were found between the treatment and placebo groups. CONCLUSIONS Treatment with PEMF may be effective in reducing pain in patients with MS, although further research is necessary to confirm its effectiveness over placebo and to differentiate which type of pain may be more susceptible to this treatment.
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Affiliation(s)
- A Hochsprung
- Fisioterapeuta. Sala de Neurofisioterapia. Unidad de EM del Hospital Virgen de la Macarena. Sevilla, Spain
| | - S Escudero-Uribe
- Fisioterapeuta. Sala de Neurofisioterapia. Unidad de EM del Hospital Virgen de la Macarena. Sevilla, Spain
| | - A J Ibáñez-Vera
- Fisioterapeuta. Universidad de Jaén. Departamento de Ciencias de la Salud, Área de Fisioterapia. Jaén, Spain.
| | - G Izquierdo-Ayuso
- Neurólogo. Unidad de EM del Hospital Virgen de la Macarena. Edificio Policlínico, Planta 1ª, Puerta nº106, 3 Avenida de Doctor Fedriani, 41009, Sevilla, Spain
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50
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Aboud T, Schuster NM. Pain Management in Multiple Sclerosis: a Review of Available Treatment Options. Curr Treat Options Neurol 2019; 21:62. [PMID: 31773455 DOI: 10.1007/s11940-019-0601-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Multiple Sclerosis (MS) is a chronic autoimmune disease with no curative treatment available. While recent years have ushered in many effective new disease-modifying therapies for MS, they have not obviated the need for symptomatic treatments for MS-related pain. In this review, we discuss available approaches to control pain, which is one of the most common complaints MS patients have. RECENT FINDINGS The most recent research in this topic is directed towards non-pharmacologic interventions including water exercises, yoga and cannabis. More trials are being conducted on neuromodulation for MS-related neuropathic pain, including transcutaneous electrical nerve stimulation (TENS) and transcranial direct current stimulation (tDCS). Pain control for MS patients is challenging, considering the progressive and relapsing remitting nature of the disease, however, it is a very important aspect of it's management, as it improves mobility, exercise tolerance, concomitant depression and overall quality of life. Future research should focus on the use of neuromodulation in controlling MS pain.
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Affiliation(s)
- Talal Aboud
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Nathaniel M Schuster
- Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, CA, USA
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