Pain In Multiple Sclerosis Abstracts

Pain is a frequent and disabling symptom among Multiple Sclerosis (MS) patients. The importance of this problem was investigated in a hospital based MS population.

A total of 142 MS patients underwent Neurological Examination and a structured interview for registration of Pain and Sensory symptoms.

One-hundred and five patients reported Sensory and/or Pain symptoms. Pain was reported by 93 patients and was most frequently located in the limbs and lumbar region.

The presence of Pain was independent of gender, age at onset and examination, disability, disease course and duration. The most frequently reported characteristics of the symptoms were Paresthesia, Neuralgia and Deep Muscular Aching.

About 40% of the patients reported that the symptoms had important influence on daily activities. Only one-third of the patients were treated for their Pain.

Pain is a frequent and disabling symptom, independent of demographic and clinical variables in MS patients. The low frequency of treatment for these symptoms indicates a need for improved attention to this problem.

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.

Background
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.

Results
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."

Conclusions
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 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.

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.

Multiple Sclerosis is a complex Neurological condition affecting Sensory and Motor Nerve transmission. Its progression and symptoms are unpredictable and vary from person to person as well as over time.

Common early symptoms include Visual Disturbances, Facial Pain or Trigeminal Neuralgia and Paresthesia or Numbness of feet, legs, hands and arms.

These, plus symptoms of Spasticity, Spasms, Tremor, Fatigue, Depression and progressive disability, impact on the individual's ability to maintain Oral health, cope with Dental treatment and access Dental services.

Also, many of the medications used in the symptomatic management of the condition have the potential to cause Dry Mouth and associated Oral Disease. There is no cure for Multiple Sclerosis, and treatment focuses on prevention of disability and maintenance of quality of life.

Increasingly a multi-disciplinary team approach is used where the individual, if appropriate his/her carer, and the specialist nurse are key figures. The Dental team plays an essential role in ensuring that Oral health impacts positively on general health.

Purpose
To examine Vision-specific health-related quality of life in a cohort of patients with Multiple Sclerosis (MS) using the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25), and to identify content areas for a brief MS-specific vision questionnaire.

Design & Methods
Cross-sectional survey. The VFQ-25 and a modified version of the Optic Neuritis Treatment Trial (ONTT) Patient Questionnaire were administered by in-person interview to 80 patients at the University of Pennsylvania MS Center.

Binocular Visual Acuities were obtained following a standard protocol using RetroIlluminated Early Treatment Diabetic Retinopathy Study Charts.

Results
Despite a median Binocular Visual Acuity of 20/16 (20/12.5-20/250), VFQ-25 subscale scores in the MS cohort were significantly lower (worse) compared with those of a published reference group of Eye Disease-free patients (P =.0001-0.009, two-tailed t tests).

Rank-correlations of VFQ-25 composite (overall) scores with Visual Acuity were modest, but significant (r(s) = 0.33, P =.003), supporting construct validity for VFQ-25 scores in MS populations.

Seven additional aspects of self-reported Visual Dysfunction in MS were also identified.

Conclusions
Patients with MS have a high degree of self-reported Visual Dysfunction that is not entirely captured by Visual Acuity. The VFQ-25 is an effective measure of self-reported visual loss in MS.

A brief MS-specific Vision questionnaire may provide additional useful information when administered concurrently with the VFQ-25 in future investigations of MS and other NeuroOphthalmologic Disorders.

According to previous studies Pain symptoms were a problem in Multiple Sclerosis (MS) patients. This is an important issue since symptom control, especially Pain, assume high priorities in MS.

The aim of study was to assess the incidence and type of Pain symptoms in MS. In the study 104 consecutive patients with Clinically Definite MS, according to Poser's Criteria, were evaluated by questionnaire.

In all patients Brain MRI strongly suggested MS. 76% of patients had Relapsing/Remitting (RR) course of the disease. At any stage of the Disease Pain Syndromes occurred in 70.2% of MS patients.

In 8% patients Pain was the first symptom of MS. The most common acute Pain syndromes were: Lhermitte Sign (26%) and painful Tonic Spasm (19%).

The incidence of Migraine was 8% and 26% had Tension Headache. Chronic Pain occurred in 60% of MS patients. Most common were Dysaesthetic Extremity Pain (45%), Low Back Pain (34%) and Painful Leg Spasm (22%).

There was no correlation with age, sex, and duration of disease. Pain symptoms were more frequent in MS patients with higher EDSS score and Spinal Cord involvement. Pain syndromes are common in MS patients.

There was no correlation with age, sex, and duration of the disease. Pain occurred more frequent in MS patients with higher EDSS score and in patients with Spinal Cord involvement.

Objective
Physical disability explains only part of the reduced quality of life found among Multiple Sclerosis (MS) patients. Bladder Dysfunction and Sexual Disturbance are frequent and distressing problems for MS patients.

We therefore estimated the relationship between the presence and degree of Sexual Disturbance/Bladder Dysfunction and the patients' quality of life as measured by the SF-36 Health Survey.

Methods
We performed a cross-sectional study of all individuals with the onset of MS between 1976 and 1986 in Hordaland County, Norway. The disease duration at examination was 9-19 years; 194 patients (94%) participated.

Results
Fifty-three per cent of the patients with low physical disability (Expanded Disability Status Scale (EDSS) < or = 4.0) reported disease-related sexual disturbance and 44% had Bladder Dysfunction according to the Incapacity Status Scale.

The corresponding figures for the patients with a high physical disability (EDSS > 4.0) were 86 and 81% respectively.

The patients with Sexual Disturbance had markedly and significantly reduced scores on all eight SF-36 scales, this was after adjustment for disease development measured by the EDSS.

The patients without Sexual Disturbance scored 0.5 s.d. lower than a normal population on the social functioning scale, whereas those with marked Sexual Disturbance scored 1.5 s.d. lower. Similar results were found for the patients with Bladder Dysfunction.

Conclusion
Bladder and Sexual problems are associated with a marked reduction in the quality of life, also among patients with otherwise low disability. This underlines the need for identifying and treating these problems.

Sexual dysfunction is a very important but often overlooked symptom of Multiple Sclerosis. To investigate the type and frequency of symptoms of Sexual Dysfunction in patients suffering from Multiple Sclerosis.

We performed a case-control study comparing 108 unselected patients with Definite Multiple Sclerosis, 97 patients with chronic disease.

And 110 healthy individuals with regard to Sexual Function, Sphincteric Function, Physical Disorders impeding Sexual activity and the impact of Sexual Dysfunction on social life.

Information has been collected from a face-to-face structured interview performed by a doctor of the same gender as the patient.

The disability, the Cognitive performances, the Psychiatric conditions and the Psychological profile of patients and controls have been assessed.

Sexual Dysfunction was present in 73.1% of cases, in 39.2% of chronic disease controls and in 12.7% of healthy controls (P<0.0001). Male cases reported symptoms of Sexual Dysfunction more frequently than female cases (P<0.002).

Symptoms of Sexual Dysfunction more commonly reported in patients with Multiple Sclerosis were Anorgasmia or Hyporgasmia (37.1%), Decreased Vaginal Lubrication (35.7%).

And Reduced Libido (31.4%) in women, and Impotence or Erectile Dysfunction (63.2%), Ejaculatory Dysfunction and/or Orgasmic Dysfunction (50%) and Reduced Libido (39.5%) in men.

Seventy-five per cent of cases, 51.5% of chronic disease controls and 28.2% of healthy controls (P<0.0001) experienced symptoms of Sphincteric Dysfunction.

In conclusion, a substantial part of our sample of patients with Multiple Sclerosis reported symptoms of Sexual and Sphincteric Dysfunction.

Both sexual and Sphincteric Dysfunction were significantly more common in patients with Multiple Sclerosis than in either control group.

Our findings suggest that a peculiar damage of the structures involved in Sexual Function is responsible for the dysfunction in patients with Multiple Sclerosis.

But the highly significant lower frequency of symptoms of Depression and Anxiety in healthy controls may also imply a possible causative role of Psychological factors.

Objective
To assess the frequency and quality of Sensory symptoms in a population of patients with Multiple Sclerosis (MS) and compare them with controls.

Design
Survey to target population and control group evaluating demographic data, data on disease course, presence of various symptoms of MS.

Setting & Participants
Neurological practices affiliated with a tertiary community hospital. 224 patients with MS, 93 controls of similar age and sex.

Results
Sensory symptoms were more common in MS patients than in controls, and differed in severity and quality. Fifty per cent described brief (seconds to hours) episodes of Neurological Dysfunction, significantly more often than in controls (P = 0.001).

Pain was present at some time in similar percentages in patients and controls, but active Pain problems were present more often in MS patients (P = 0.001).

The qualitative description of Pain in MS patients was more often Neuropathic, with burning, itching, electric and formicatory Pain, as opposed to throbbing, sharp or muscular Pain.

Pain was localized to arms, legs, trunk, hands, feet and face more often in the MS group. Lhermitte's Phenomenon was present in two-thirds of patients at some time in their disease course.

Twenty per cent of the patients identified themselves as having Respiratory problems (Controls 7.5%, P = 0.005). Fatigue limited activity in 78% of patients, but only in 17% of controls (P = 0.001).

Dizziness, Memory Dysfunction, and Restless Legs symptoms were all more frequent in patients. The self-rated 'worst' symptoms of MS was Pain in 12%, Fatigue in 17% and Dizziness in 5%, a total of 34% of 'worst' symptoms.

Sensory symptoms were present in patients with early disease and without disability as often as in disabled patients and in those with longer disease duration. There was however a strong correlation between the total number of Sensory symptoms reported and the presence of disability in the MS patients.

Conclusions
Sensory symptoms are common in MS patients. Pain Syndromes, transient Neurologic Events, Lhermitte's Phenomenon, Fatigue, Respiratory Symptoms and Vertigo were present significantly more frequently in patients with MS than in a control population and contributed to subjective morbidity.

Future clinical trials assessing therapy in MS might include Sensory symptoms as secondary endpoints to capture this 'hidden reservoir' of disease morbidity.