Clinical exacerbations of multiple sclerosis and the features of pain associated with MS

Abstract

Background and goals: Little is known regarding the relationship between exacerbations of multiple sclerosis (MS) and the occurrence, type and intensity of pain. Our aim was to evaluate pain features of MS patients with clinical relapses, and to compare with the patients on MS remissions and controls. Methods: It was a prospective study of the all MS patients with pain, who referred to both Neurological Out- and In-patient Departments during a period of Mar-Apr of 2009 and 2010. All the patients underwent a structured interview and neurological examination. A Visual Analogue Scale (VAS), McGill Pain Questionnaire (MPQ), Neuropathic Pain Symptom Inventory (NPSI), 36-item Short Form Health Survey (SF36), Hamilton Depression Scale (HamD), as well an algometer, cuff-algometry were employed as pain assessment tools. Results: Altogether 72 patients were thoroughly analyzed: 20- with pain and MS exacerbation (group 1), 25- with pain and MS remission (group 2), 27- experiencing pain with other neurological disease (group 3). The mean duration of MS symptoms (group 1 vs. 2) was 8.0±3.5 vs. 8.9±5.0 years and the EDSS scores were of 4.3±1.8 vs. 3.0±1.9 points (p=0.02), mean age- 43.4±10.4 vs. 38.5±10.6 years. 86.7% of all MS patients had relapsing-remitting clinical course, 80% were female. For the majority in group 1, pain was chronic-exacerbated (N=11, 55%), in group 2- chronic (21; 84%) (Chi 2=42.5, p<0.001), in group 3- chronic (N=14, 51.9%). There was most often designated spontaneous ongoing pressing pain component by 16 (80%) of group 1 patients with intensity of 3.5±2.7 points; paresthesia/dysesthesia- by 19 (76%) with 3.3±3.2 points of group 2; evoked- by 25 (92.6%) with 3.9±3.1 points of group 3 in NPSI. According to MPQ, sensory pain-words were more frequently used (p=0.01) in all groups, but higher affective component was in group 1 and 2 by HamD scores (p=0.008). VAS measures (43.3±2 [...].