Multipl Skleroz Hastalarında Ağrı ve İlişkili Klinik Özellikler

Abstract

Objectives: Even though multiple sclerosis (MS) is not considered to be a painful disease, painful symptoms are frequently encountered in patients with MS. Theobjective of this study was to investigate various types of pain and clinical features associated with these pains in patients with MS. Materials and Methods: Seventy consecutive patients followed up with relapsing remitting MS were included in the study. Besides demographic and clinical characteristics of patients, expanded disability status scale (EDSS) scores, cranial and spinal demyelinating lesions were recorded. Patients were investigated for migraine, tension-type headache (TTH), treatment-related headache, Lhermitte sign, neuropathic limb pain, painful tonic spasms, low back pain, and mechanical limb pain, and also evaluated for associated fatigue, depression and anxiety symptoms. Results: Of the 70 patients (54 females, 16 males, mean age 36.2±7.9) 64 had one or more painful disorders (91.4%). Low back pain was the most common painful symptom (48.6%) followed by migraine (38.6%) and treatment-related headache (31.1%). Fatigue, depression and anxiety were found to be more frequently in patients with migraine than in those without migraine (p=0.027, p=0.01 and p=0.016, respectively). The duration of MS was longer in patients with neuropathic pain (p=0.018). Patients with neuropathic limb pain, Lhermitte sign, and low back pain had higher EDSS scores (p<0.001, p=0.007 and p=0.035, respectively). It was found that depression was more frequent in patients with neuropathic limb pain (p=0.005) and anxiety was more frequent in patients with low back pain (p=0.03). Demyelinating lesions were found to be more frequent in internal capsule in patients with TTH (p=0.05); in internal capsule and cervical spinal cord in patients with neuropathic limb pain (p=0.033and p=0.019, respectively); and in pons and cervical spinal cord in patients with Lhermitte sign (p=0.031 and p<0.001, respectively). Conclusion: The results of our study have shown that pain is a very common symptom in patients with MS and have pointed out that patients with MS may have a wide variety of pain in which neurogenic or nociceptive mechanisms play a role. Identification of pain will be helpful to initiate appropriate treatment and to improve the quality of life in patients with MS.

Keywords

• Multiple Sclerosis
• Pain
• Headache
• Migraine
• Neuropathic Pain

References

1. 1. Stenager E, Knudsen L, Jensen K. Acute and chronic pain syndromes in multiple sclerosis. A 5-year follow-up study. Ital J Neurol Sci. 1995;16:629-632.
2. 2. O’Connor AB, Schwid SR, Herrmann DN, et al. Pain associated with multiple sclerosis: systematic review and proposed classification. Pain. 2008;137:96-111.
3. 3. Beiske AG, Pedersen ED, Czujko B, et al. Pain and sensory complaints in multiple sclerosis. Eur J Neurol. 2004;11:479-482.
4. 4. Solaro C, Brichetto G, Amato MP, et al. The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study. Neurology. 2004;63:919-921.
5. 5. Osterberg A, Boivie J, Thuomas KA. Central pain in multiple sclerosis--prevalence and clinical characteristics. Eur J Pain. 2005;9:531-542. [Epub 2004 Dec 22]
6. 6. Fryze W, Zaborski J, Członkowska A. Pain in the course of multiple sclerosis. Neurol Neurochir Pol. 2002;36:275-284.
7. 7. Truini A, Galeotti F, La Cesa S, et al. Mechanisms of pain in multiple sclerosis: a combined clinical and neurophysiological study. Pain. 2012;153:2048-2054.
8. 8. Moisset X, Ouchchane L, Guy N, et al. Migraine headaches and pain with neuropathic characteristics: comorbid conditions in patients with multiple sclerosis. Pain. 2013;154:2691-2699.

9. 9. Hadjimichael O, Kerns RD, Rizzo MA, et al. Persistent pain and uncomfortable sensations in persons with multiple sclerosis. Pain. 2007;127:35-41.
10. 10. Kalia LV, O’Connor PW. Severity of chronic pain and its relationship to quality of life in multiple sclerosis. Mult Scler J. 2005;11:322-327.
11. 11. Khan F, Pallant J. Chronic pain in multiple sclerosis: prevalence, characteristics, and impact on quality of life in an Australian community cohort. J Pain. 2007;8:614-623.
12. 12. Solaro C, Trabucco E, Messmer Uccelli M. Pain and multiple sclerosis: pathophysiology and treatment. Curr Neurol Neurosci Rep. 2013;13:320.
13. 13. Truini A, Barbanti P, Pozzilli C, et al. A mechanism-based classification of pain in multiple sclerosis. J Neurol. 2013;260:351-367.
14. 14. Haas DC, Kent PF, Friedman DI. Headache caused by a single lesion of multiple sclerosis in the periaqueductal gray area. Headache. 1993;33:452-454.
15. 15. Gee JR, Chang J, Dublin AB, et al. The association of brainstem lesions with migraine-like headache: an imaging study of multiple sclerosis. Headache. 2005;45:670-677.
16. 16. Mazhari A. Multiple Sclerosis-Related Pain Syndromes: An Imaging Update. Curr Pain Headache Rep. 2016;20:63.
17. 17. Martinelli Boneschi F, Colombo B, Annovazzi P, et al. Lifetime and actual prevalence of pain and headache in multiple sclerosis. Mult Scler J. 2008;14:514-521.
18. 18. Grau-López L, Sierra S, Martínez-Cáceres E, et al. Analysis of the pain in multiple sclerosis patients. Neurologia. 2011;26:208-213.
19. 19. Kister I, Caminero AB, Monteith TS, et al. Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course. J Headache Pain. 2010;11:417-425.
20. 20. Sahai-Srivastava S, Wang SL, Ugurlu C, et al. Headaches in multiple sclerosis: Cross-sectional study of a multiethnic population. Clin Neurol Neurosurg. 2016;143:71-75.
21. 21. Gebhardt M, Kropp P, Hoffmann F, et al. Headache in the course of multiple sclerosis: a prospective study. J Neural Transm (Vienna). 2019;126:131-139.
22. 22. Beckmann Y, Türe S. Headache characteristics in multiple sclerosis. Mult Scler Relat Disord. 2019;27:112-116.
23. 23. D’Amico D, La Mantia L, Rigamonti A, et al. Prevalence of primary headaches in people with multiple sclerosis. Cephalalgia. 2004;24:980-984.
24. 24. Kister I, Caminero AB, Herbert J, et al. Tension-type headache and migraine in multiple sclerosis. Curr Pain Headache Rep. 2010;14:441-448.
25. 25. Nicoletti A, Patti F, Lo Fermo S, et al. Headache and multiple sclerosis: a population-based case-control study in Catania, Sicily. Cephalalgia. 2008;28:1163-1169.
26. 26. Putzki N, Pfriem A, Limmroth V, et al. Prevalence of migraine, tensiontype headache and trigeminal neuralgia in multiple sclerosis. Eur J Neurol. 2009;16:262-267.
27. 27. Pakpoor J, Handel AE, Giovannoni G, et al. Meta-analysis of the relationship between multiple sclerosis and migraine. PLoS One. 2012;7:e45295. [Epub 2012 Sep 14]. Erratum in: PLoS One. doi: 10.1371/annotation/274e5ef1-79aa-48f7-af62-0594d5c1354e.
28. 28. Mitsikostas DD, Thomas AM. Comorbidity of headache and depressive disorders. Cephalalgia. 1999;19:211-217.
29. 29. Marrie RA. Comorbidity in multiple sclerosis: implications for patient care. Nat Rev Neurol. 2017;13:375-382.
30. 30. Howell OW, Reeves CA, Nicholas R, et al. Meningeal inflammation is widespread and linked to cortical pathology in multiple sclerosis. Brain. 2011;134:2755-2771.
31. 31. Melo-Carrillo A, Strassman AM, Nir RR, et al. Fremanezumab-A Humanized Monoclonal Anti-CGRP Antibody-Inhibits Thinly Myelinated (Aδ) But Not Unmyelinated (C) Meningeal Nociceptors. J Neurosci. 2017;37:10587-10596.
32. 32. Levy D. Migraine pain, meningeal inflammation, and mast cells. Curr Pain Headache Rep. 2009;13:237-240.
33. 33. Tortorella P, Rocca MA, Colombo B, et al. Assessment of MRI abnormalities of the brainstem from patients with migraine and multiple sclerosis. J Neurol Sci. 2006;244:137-141.
34. 34. La Mantia L, D’Amico D, Rigamonti A, et al. Interferon treatment may trigger primary headaches in multiple sclerosis patients. Mult Scler J. 2006;12:476-480.
35. 35. Pöllmann W, Erasmus LP, Feneberg W, et al. Interferon beta but not glatiramer acetate therapy aggravates headaches in MS. Neurology. 2002;59:636-639.
36. 36. Filippini G, Munari L, Incorvaia B, et al. Interferons in relapsing remitting multiple sclerosis: a systematic review. Lancet. 2003;361:545-552.
37. 37. Foley PL, Vesterinen HM, Laird BJ, et al. Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis. Pain. 2013;154:632-642.
38. 38. Nurmikko TJ, Gupta S, Maclver K. Multiple sclerosis-related central pain disorders. Curr Pain Headache Rep. 2010;14:189-195.