The place of pain in the structure of neurological symptoms in patients with multiple sclerosis and the characteristics that affect the prioritization of pain by the patient

Abstract

Objective — to evaluate the place of pain in the structure of neurological symptoms from the patient’s point of view in patients with multiple sclerosis and determine the characteristics of the MS, pain syndromes and social factors that affect the perception of pain as a most disturbing symptom in patients with MS. Methods and subjects. 104 patients with a confirmed diagnosis of multiple sclerosis and existing pain syndromes were examined. An analysis of medical records, neurological and general medical examination, medical history and history of pain, as well as life history with clarification of education background and religiousness were conducted. VAS and SF‑MPQ2 questionnaires were used to assess the characteristics of pain syndromes. Patients were asked which multiple sclerosis syndrome disturbed them the most. Results. Among the examined patients with MS, pain was the most disturbing syndrome for 41.3 % of patients. Gender and religiosity did not affect this perception. There was a tendency to more frequent perception of pain as the syndrome that disturbed the most among patients with lower levels of education, but this trend was not statistically significant (p = 0.14). Among patients with pain as the syndrome that disturbs them the most, there is a larger proportion of patients with a small number of MS relapses (1 — 10): 65.1 ± 7.3 % vs. 44.3 ± 6.4 %, respectively, p = 0.04. Among patients who considered pain to be the first manifestation of MS, pain was considered to be the most disturbing syndrome more often (p = 0.02). The results of pain characteristics comparison based on SF‑MPQ‑2 results showed significantly higher rates of continuous, intermittent pain components of pain in patients with pain as the most disturbing syndrome: 27.0 [18.5; 36.5] and 21.0 [10.0; 33.0] point, p = 0.04; 20.0 [13.0; 30.0] and 12.0 [4.0; 26.0] points, p = 0.03, respectively. The VAS scores of strongest pain for the last month where higher in the group of patients whose pain was the most disturbing syndrome — 8 [7; 9] points than in the group of patients whose pain was not the most disturbing syndrome — 6 [4; 8] points (p = 0.0001). The proportion of patients with pain, as the most disturbing symptom of MS, was 2.2 times higher than the proportion of patients for whom pain was not the most disturbing symptom of MS in the group with the strongest pain intensity for the last month of 8 — 10 points: 67.4 ± 7.1 % vs. 31.1 ± 5.9 %, respectively (p = 0.0003). A similar difference was found when comparing the distribution of patients by the intensity of average pain per month, where the proportion of patients with high‑intensity average pain per month is more than 2 times higher among patients who consider pain the syndrome that disturbing them the most in the structure of MS. Conclusions. More than a third of MS patients consider pain as a most disturbing symptom in the structure of this disease. Such an assessment of pain does not depend on gender or religiosity, however, may have some connection with the education level. Pain syndromes, as the most disturbing symptom of MS, will be more common among people in the first years of the disease, with a small number of MS relapses. While assessing the characteristics of pain structure, we found that among patients who consider pain as a most disturbing syndrome there were higher characteristics of continuous, intermittent components of pain, without differences in affective and neuropathic components. An important factor in this perception is the intensity of the strongest pain per month, as well as the average intensity of pain per month.