Клинические особенности болевого синдрома при демиелинизирующих заболеваниях с поражением спинного мозга

Abstract

Study Objective: To study the clinical features of pain syndrome (PS) in demyelinating diseases (DS) with spinal cord damage on the example of patients with multiple sclerosis (MS) or spectrum of neuroopticomyelitis disoders (NMOSD). Study Design: Cross-sectional study. Materials and Methods. 30 patients with demyelinating diseases and spinal cord injury were examined. All patients were divided into two groups: with PS (n = 20, of which patients with MS — 10, with NMOSD — 10) and without it (n = 10, of which patients with MS — 7, with NMOSD — 3). All participants underwent standard interviewing, assessment of neurological status, pain intensity on a 10-point visual analog scale (VAS), the degree of general disability on the Expanded Disability Status Scale, and also filled out questionnaires on the presence of neuropathic PS (DN4), Beck's anxiety and depression, quality of life Short Form 36-item health survey. Study Results. The duration of PS was on average 23.5 ± 1.3 days in patients with MS and 46.6 ± 2.4 days in patients with NMOSD (p = 0.000014). There was no statistically significant difference in the intensity of PS according to VAS between the study groups. When analyzing the scores on the SF-36 quality of life scale, a statistically significant difference was revealed in mental health indicators (with PS — 30.1 ± 2.6, without PS — 50.77 ± 3.39 points, p = 0.000182), social activity (with PS — 30.35 ± 10.37, without PS — 77.33 ± 6.5 points, p = 0.00145), role functioning associated with physical factors (with PS — 27.5 ± 3.31, without PS — 44.22 ± 5.55 points, p = 0.0019842), role functioning associated with emotional factors (with PS — 27.6 ± 11.38, without PS — 70.67 ± 14.74 points, p = 0.001649), as well as in the intensity of PS (with PS — 38.80 ± 7.27, without PS — 73.56 ± 6.56 points, p = 0.001571). According to the Beck scale of anxiety and depression, depression was significantly more common in patients with PS (p = 0.002). Conclusion. Neuropathic pain in NMOSD is more intense and prolonged, and the characteristics of pain do not depend on age, gender and duration of the disease. In patients with PS, the indicators of the mental component of health, social and role functioning are reduced. Statistically significant differences in these indicators between patients with MS and NMOSD were not revealed. Keywords: multiple sclerosis, spectrum of neuroopticomyelitis disoders, neuropathic pain, painful tonic muscle spasms, pain syndrome.