Pain In Multiple Sclerosis - A Still Underestimated Problem. The 1 Year Prevalence Of Pain Syndromes, Significance And Quality Of Care Of Multiple Sclerosis Inpatients
Pollmann W, Feneberg W, Erasmus LP
Nervenarzt 2004 Feb;75(2):135-40
We evaluated the 1-year prevalence of Pain Syndromes and quality of care among 157 consecutive Multiple Sclerosis (MS) inpatients (90 f, 67 m) aged 19-85 years, with Extended Disability Status Scores of 1.0-8.5 and Clinically Definite MS.
In a standardized questionnaire, only Severe Pain (Pain intensity on Visual Analog Scale of at least 4/10) was documented and classified which had occurred more often than three times or lasted longer than 1 week within the last year.
Of 157 patients, 61% reported 176 Pain Syndromes: most frequent were Headaches (40%), Dysesthetic Limb Pain (19%), Back Pain (17%), and Painful Spasms (11%).
Twelve percent of the Pain Syndromes were classified as worst symptom of MS, and in 68% insufficient care by the physicians consulted was reported.
This was even true for the most frequent Pain, Migraine, in which clear treatment recommendations exist. There is thus an urgent need for physicians to keep this problem in mind when treating MS patients.
Pain In Multiple Sclerosis: A Population-Based Study
Svendsen KB, Jensen TS, Overvad K, Hansen HJ, Koch-Henriksen N, Bach FW
Arch Neurol 2003 Aug;60(8):1089-94
Danish Pain Research Center, Building 1A, Aarhus University Hospital, Noerrebrogade 44, DK-8000 Aarhus C, Denmark
Pain is an important symptom in patients with Multiple Sclerosis (MS). The estimated Pain prevalence varies between 30% and 90%. To our knowledge, previous studies do not include a whole population sample of patients with MS.
Objective & Design
To assess Pain prevalence and its clinical characteristics and impact on daily life in a population sample of MS patients and in a reference group -- postal survey.
Setting & Participants
Aarhus County, Denmark. The population of patients with Definite MS in Aarhus County (n = 771) and a sex- and age-stratified reference group from the general population (n = 769).
Main Outcome Measures
Pain prevalence, intensity, and treatment requirement; and the impact of Pain on daily life.
Response rates for MS patients and reference subjects were 81.3% and 63.3%, respectively. Pain in the month preceding assessment occurred in 79.4% of MS patients and in 74.7% of reference subjects (prevalence proportion ratio, 1.06; 95% confidence interval, 0.99-1.13).
Patients with MS had a higher Pain intensity ("when Pain is at its least" Median Visual Analog Scale Score, 20.0 vs 11.0 mm [P<.01];and "when Pain is at its worst" Median Visual Analog Scale Score, 68.0 vs 55.0 mm [P<.01]).
Daily intake of analgesics occurred in 24.4% of MS patients and 9.0% of reference subjects (prevalence proportion ratio, 2.7; 95% confidence interval, 2.0-3.6).
Patients with MS more often reported that Pain interfered with daily life "most of the time" or "all the time."
The frequency of reported Pain in MS patients was not higher than in the background population. However, Pain intensity, the need for analgesic treatment, and the impact of Pain on daily life were higher in MS patients.
Pain And Multiple Sclerosis
Solaro C, Lunardi GL, Mancardi GL
Int MS J 2003 Apr;10(1):14-9
PA Micone Hospital, Department of Neurology, Genoa, Italy
Pain is frequently evident in the course of Multiple Sclerosis (MS) and is estimated to occur in approximately 50% of patients. The incidence of Pain has no apparent correlation to disease severity.
Moreover, a comprehensive definition of Pain has not been established, thus making the evaluation of this chronic, evolving symptom difficult.
On the basis of its PathoPhysiology, Pain can occur as a consequence of Neurological impairment and disability, Somatic Pain or because of Neurological damage.
Although there are few randomized trials for Pain in MS, new therapeutic strategies are now available and interest in the symptomatic treatment of MS is growing.
Pain In Multiple Sclerosis: A BioPsychosocial Perspective
Kerns RD, Kassirer M, Otis J
J Rehabil Res Dev 2002 Mar-Apr;39(2):225-32
VA Connecticut Healthcare System and Yale University, West Haven, CT 06516, USA
Clinically significant pain has been found in as many as 65% of persons diagnosed with Multiple Sclerosis (MS). Acute Pain conditions include Trigeminal Neuralgia, Painful Optic Neuritis, and Lhermitte's Syndrome.
Chronic Pain conditions such as Dysesthesias in the limbs, joint pain, and other MusculoSkeletal or Mechanical Pain problems develop as a function of Spasticity and deconditioning associated with MS.
These painful conditions may respond to Pharmacological, Surgical, Rehabilitation, and Psychological interventions. However, unresolved Pain, associated disability, and Affective Distress are common.
In addition, efforts to manage MS and its associated symptoms, for example, may inadvertently cause Osteoporosis and Headache or other symptoms that may exacerbate Pain and Pain-related disability.
Conversely, efforts to manage Pain may have negative effects on the symptoms of MS (e.g., increased Fatigue). A multidimensional approach to assessment and management that is guided by a comprehensive BioPsychosocial model is recommended.
Such an approach needs to consider the exacerbating nature of MS, MS-related Pain, and interventions aimed at their management. Suggestions for future research on MS-related Pain conclude the article.