Abstract
About half of patients with multiple sclerosis (MS) report pain; treatment for pain alone accounts for nearly 30% of the total use of medications for the management of all MS-related symptoms. Patients with MS can experience more than one type of pain simultaneously and at any point during the disease course, even in newly or recently diagnosed cases. Pain in MS can be associated with other symptoms, including spasticity, fatigue and mood disorder. Pain sufferers experience disruption in daily life activities, work, mood, recreation and general enjoyment of life, and report low satisfaction with pain management. Many clinical features of pain are often unrecognized by clinicians and are difficult for patients to describe. The majority of clinical evidence regarding treatment stems from small pilot and open-label studies; therefore, treatment of pain associated with MS is often based on anecdotal reports and clinicians' experience. The open-label design of the majority of studies, the unavailability of large samples and the difficulty of performing placebo-controlled studies because of ethical considerations result in insufficient evidence to support or refute the effectiveness of pain medications. This Review presents available data regarding pharmacological approaches for addressing pain in MS and highlights the shortcomings in pain management research.
Key Points
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Pain syndromes are common in individuals with multiple sclerosis (MS), even early in the disease, and differentiating neuropathic from non-neuropathic pain is difficult
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Pain treatment in MS requires vigilance; patients can experience more than one type of pain, necessitating multiple pharmacological interventions, which can cause compounded adverse events, including clinical worsening of MS
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Literature on pain management is lacking, particularly reports of randomized clinical trials, and clinicians often rely on experience and anecdotal reports for deciding treatment regimens
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Although potentially effective for treating some types of pain in MS, tricyclic antidepressants and antiepileptic medications have notable adverse events, which often prohibits use of these drugs to their full potential
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Correct identification and effective management of pain are crucial, as pain can markedly influence quality of life, including, among others, everyday activities, work and mood
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Progress in the area of pain associated with MS will depend on the development of multiple-arm, randomized clinical trials to determine optimal treatment strategies
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Acknowledgements
The authors would like to thank the Italian Multiple Sclerosis Society and S. Minguzzi, Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Italy, for support in preparing this Review.
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Solaro, C., Messmer Uccelli, M. Management of pain in multiple sclerosis: a pharmacological approach. Nat Rev Neurol 7, 519–527 (2011). https://doi.org/10.1038/nrneurol.2011.120
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DOI: https://doi.org/10.1038/nrneurol.2011.120