Central Pain in Patients with Multiple sclerosis

Abstract

Central pain (CP) is little recognized and diagnosed type of pain in multiple sclerosis. Objective: This second part of our work related to pain in multiple sclerosis is concentrated on occurrence of CP and defined its characteristics. Methods: Questionnaires on pain were sent to 307 patients with definitive multiple sclerosis diagnose. Patients admitting to CP were examined with aim to diagnose CP. The dates were statistically processed. Results: Out of 220 responders 92% reported pain during the course of their multiple sclerosis. CP was found in 57.72%, including 40.91% with central neuropathic extremity and trunk pain (CNEP), 5.91% with trigeminal neuralgia (TN), and 33.18% with Lhermitte‘s sign (LS). In 28.8% of all patients, CP was an initial multiple sclerosis symptom. The prevalence of CP does not increase with age, disease duration, or the Expanded Disability Status Scale (EDSS). Lower extremities were the commonest location of CNEP (74.5%) and burning was the commonest painful sensation. Three and more concurrent unpleasant painful sensations experienced 68.9% of patients, which were in 46.7% located in the lower extremities. Three and more concurrent CP locations (including TN and LS) were reported by 89% of patients. Number of locations in CP increases significantly with age and EDSS, in contrast to group with nociceptive and peripheral neuropathic pain (n=113), where does not increase with age, EDSS and multiple sclerosis duration. The group with nociceptive and peripheral neuropathic pain featured significantly less patients with only one pain location (p=0.0269) and only one pain quality. In contrast to the other group, In CP increases significantly the number of patients with increase the number of concurrent pain qualities (p<0.0001). Conclusion: CP is not only a frequent complaint among persons with multiple sclerosis, but is a distinctive type of pain requiring special attention and their identification remains still the major challenge.