Невропатические болевые синдромы у больных с рассеянным склерозом: патогенез, диагностика, тактика ведения пациентов

Abstract

Neuropathic pain syndromes (NPS), pathogenetically associated with the demyelinating process in the central nervous system and patient maladjustment, are commonly found in patients with multiple sclerosis (MS). Primarily, the diagnosis of NPS is based on a careful analysis of clinical symptoms, while the MRI data and neurophysiological methods are of auxiliary importance. Difficulties in the NPS treatment are due to the patterns of pathogenetic mechanisms that determine the chronic nature of NPS, as well as limited efficacy and common adverse events of the drug therapy. The review examines modern views concerning the main variants of NPS in MS (persistent extremity pain, trigeminal neuralgia, Lhermitte’s sign, painful tonic spasms), describes the patterns of pathogenesis and clinical manifestations of each syndrome, provides data on the information value of additional examination methods, analyzes existing methods to conservative therapy based on the randomized trials data. Particular attention is paid to the following points in patient management with NPS: setting adequate treatment goals, choosing medications, using rational combined pharmacotherapy and non-drug treatment methods, increasing patients’ adherence to therapy. KEYWORDS: multiple sclerosis, neuropathic pain syndromes, persistent extremity pain, trigeminal neuralgia, Lhermitte’s sign, painful tonic spasms, treatment tactics of neuropathic pain. FOR CITATION: Kiselev D.V., Spirin N.N., Baranova N.S., Karpova M.S. Neuropathic pain syndromes in patients with multiple sclerosis: pathogenesis, diagnosis, patient management. Russian Medical Inquiry. 2022;6(10):556–562 (in Russ.). DOI: 10.32364/2587-6821-2022- 6-10-556-562.