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Systematic assessment and characterization of chronic pain in multiple sclerosis patients

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Abstract

Pain is one of the most disabling clinical symptoms in patients with multiple sclerosis (MS). Several studies have already assessed the prevalence of pain in MS patients, reporting variable results, probably due to methodological differences. The aim of this single-centre cross-sectional study was to define the prevalence and characteristics of chronic pain in a population of MS patients using validated tools, and to analyse these data in relation to demographic and clinical features, including disease duration and disability (EDSS and its single functional system scores). Of 397 enrolled patients, 23 were excluded due to a Beck’s Depression Inventory Score > 19. In the remaining 374 patients, the overall prevalence of chronic pain was 52.1%, most frequently affecting the lower limbs (36.9%). Neuropathic pain was the most frequent type of chronic pain (89 patients, overall prevalence of 23.7%) and was associated with a sensory functional system involvement. Pain intensity was significantly higher in patients with neuropathic pain as opposed to patients with non-neuropathic pain. Patients with chronic pain and, in particular, patients with neuropathic pain had significantly higher EDSS scores than those without pain. Only 24% of patients with chronic pain and 33% of patients with neuropathic pain were on a specific long-lasting treatment for pain. The present study supports the routine assessment of neuropathic pain in MS patients, especially in those with a sensory functional system involvement, in order to avoid underdiagnosing and undertreating a potentially disabling condition.

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References

  1. Clifford DB, Trotter JL (1984) Pain in multiple sclerosis. Arch Neurol 41(7):1270–1272. https://doi.org/10.1212/WNL.39.7.1001

    Article  CAS  PubMed  Google Scholar 

  2. Kalia LV, O’Connor PW (2005) Severity of chronic pain and its relationship to quality of life in multiple sclerosis. Mult Scler 11(3):322–327. https://doi.org/10.1191/1352458505ms1168oa

    Article  PubMed  Google Scholar 

  3. Khan F, Pallant J (2007) Chronic pain in multiple sclerosis: prevalence, characteristics, and impact on quality of life in an Australian community cohort. J Pain 8(8):614–623. https://doi.org/10.1016/j.jpain.2007.03.005

    Article  PubMed  Google Scholar 

  4. Martinelli Boneschi F, Colombo B, Annovazzi P, Martinelli V, Bernasconi L, Solaro C, Comi G (2008) Lifetime and actual prevalence of pain and headache in multiple sclerosis. Mult Scler 14(4):514–521. https://doi.org/10.1177/1352458507085551

    Article  CAS  PubMed  Google Scholar 

  5. Moulin DE (1989) Pain in multiple sclerosis. Neurol Clin 7(2):321–331

    CAS  PubMed  Google Scholar 

  6. Solaro C, Trabucco E, Messmer Uccelli M (2013) Pain and multiple sclerosis: pathophysiology and treatment. Curr Neurol Neurosci Rep 13(1):320. https://doi.org/10.1007/s11910-012-0320-5

    Article  PubMed  Google Scholar 

  7. Hirsh AT, Turner AP, Ehde DM, Haselkorn JK (2009) Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors. Arch Phys Med Rehabil 90(4):646–651. https://doi.org/10.1016/j.apmr.2008.10.019

    Article  PubMed  PubMed Central  Google Scholar 

  8. Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT (2013) Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis. Pain 154(5):632–642. https://doi.org/10.1016/j.pain.2012.12.002

    Article  PubMed  Google Scholar 

  9. O’Connor AB, Schwid SR, Herrmann DN, Markman JD, Dworkin RH (2008) Pain associated with multiple sclerosis: systematic review and proposed classification. Pain 137(1):96–111. https://doi.org/10.1016/j.pain.2007.08.024

  10. Campbell JN, Meyer RA (2006) Mechanisms of neuropathic pain. Neuron 52(1):77–92. https://doi.org/10.1016/j.neuron.2006.09.021

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Scholz J, Woolf CJ (2002) Can we conquer pain? Nat Neurosci 5(Supp):1062–1067. https://doi.org/10.1038/nn942

    Article  CAS  PubMed  Google Scholar 

  12. Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J (2008) Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 70(18):1630–1635. https://doi.org/10.1212/01.wnl.0000282763.29778.59

    Article  CAS  PubMed  Google Scholar 

  13. Turk DC, Okifuji A (2001) Pain terms and taxonomies. In: Loeser D, Butler SH, Chapman JJ, Turk DC (eds) Bonica’s Manag. Pain, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 18–25

    Google Scholar 

  14. Main CJ, Spanswick CC (2000) Pain management: an interdisciplinary approach. Churchill Livingstone, London

    Google Scholar 

  15. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D (2006) Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 10(4):287–333. https://doi.org/10.1016/j.ejpain.2005.06.009

    Article  PubMed  Google Scholar 

  16. Merskey H, Bogduk N (1994) Classification of chronic pain. IASP Pain Terminol 57(3):425–429. https://doi.org/10.1002/ana.20394

    Google Scholar 

  17. Truini A, Barbanti P, Pozzilli C, Cruccu G (2013) A mechanism-based classification of pain in multiple sclerosis. J Neurol 260(2):351–367. https://doi.org/10.1007/s00415-012-6579-2

    Article  CAS  PubMed  Google Scholar 

  18. Chopra K, Arora V (2014) An intricate relationship between pain and depression: clinical correlates, coactivation factors and therapeutic targets. Expert Opin Ther Targets 18(2):159–176. https://doi.org/10.1517/14728222.2014.855720

    Article  PubMed  Google Scholar 

  19. Hadjimichael O, Kerns RD, Rizzo MA, Cutter G, Vollmer T (2007) Persistent pain and uncomfortable sensations in persons with multiple sclerosis. Pain 127(1):35–41. https://doi.org/10.1016/j.pain.2006.07.015

    Article  PubMed  Google Scholar 

  20. Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS (1997) Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 13(2):116–137. https://doi.org/10.1097/00002508-199706000-00006

    Article  CAS  PubMed  Google Scholar 

  21. Alschuler KN, Ehde DM, Jensen MP (2013) Co-occurring depression and pain in multiple sclerosis. Phys Med Rehabil Clin N Am 24(4):703–715. https://doi.org/10.1016/j.pmr.2013.06.001

    Article  PubMed  Google Scholar 

  22. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33(11):1444–1452. https://doi.org/10.1212/WNL.33.11.1444

    Article  CAS  PubMed  Google Scholar 

  23. Stenager E, Knudsen L, Jensen K (1995) Acute and chronic pain syndromes in multiple sclerosis. A 5-year follow-up study. Ital J Neurol Sci 16(8):629–632. https://doi.org/10.1007/BF02230913

    Article  CAS  PubMed  Google Scholar 

  24. Heitmann H, Biberacher V, Tiemann L, Buck D, Loleit V, Selter RC, Knier B, Tölle TR, Mühlau M, Berthele A, Hemmer B, Ploner M (2015) Prevalence of neuropathic pain in early multiple sclerosis. Mult Scler J 22(9):8–11. https://doi.org/10.1177/1352458515613643

    Google Scholar 

  25. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302. https://doi.org/10.1002/ana.22366

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ohayon MM, Stingl JC (2012) Prevalence and comorbidity of chronic pain in the German general population. J Psychiatr Res 46(4):444–450. https://doi.org/10.1016/j.jpsychires.2012.01.001

    Article  PubMed  Google Scholar 

  27. Blyth FM, March LM, Brnabic AJM, Jorm LR, Williamson M, Cousins MJ (2001) Chronic pain in Australia: a prevalence study. Pain 89(2):127–134. https://doi.org/10.1016/S0304-3959(00)00355-9

    Article  CAS  PubMed  Google Scholar 

  28. Caraceni A, Mendoza TR, Mencaglia E, Baratella C, Edwards K, Forjaz MJ, Martini C, Serlin RC, de Conno F, Cleeland CS (1996) A validation study of an Italian version of the Brief Pain Inventory (Breve Questionario per la Valutazione del Dolore). Pain 65(1):87–92. https://doi.org/10.1016/0304-3959(95)00156-5

    Article  CAS  PubMed  Google Scholar 

  29. De Benedittis G, Massei R, Nobili R, Pieri A (1988) The Italian pain questionnaire. Pain 33(1):53–62. https://doi.org/10.1016/0304-3959(88)90203-5

    Article  PubMed  Google Scholar 

  30. Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, Rostaing S, Lanteri-Minet M, Collin E, Grisart J, Boureau F (2004) Development and validation of the Neuropathic Pain Symptom Inventory. Pain 108(3):248–257. https://doi.org/10.1016/j.pain.2003.12.024

    Article  PubMed  Google Scholar 

  31. Spallone V, Morganti R, D’Amato C, Greco C, Cacciotti L, Marfia GA (2012) Validation of DN4 as a screening tool for neuropathic pain in painful diabetic polyneuropathy. Diabet Med 29(5):578–585. https://doi.org/10.1111/j.1464-5491.2011.03500.x

    Article  CAS  PubMed  Google Scholar 

  32. Padua L, Briani C, Jann S, Nobile-Orazio E, Pazzaglia C, Morini A, Mondelli M, Ciaramitaro P, Cavaletti G, Cocito D, Fazio R, Santoro L, Galeotti F, Carpo M, Plasmati R, Benedetti L, Schenone A, Marchettini P, Cruccu G (2009) Validation of the Italian version of the Neuropathic Pain Symptom Inventory in peripheral nervous system diseases. Neurol Sci 30(2):99–106. https://doi.org/10.1007/s10072-009-0025-y

    Article  PubMed  Google Scholar 

  33. Beck AT, Ward CH, Mendelson M et al (1961) An inventory for measuring depression. Arch Gen Psychiatry 4(6):561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004

    Article  CAS  PubMed  Google Scholar 

  34. Moulin DE, Foley KM, Ebers GC (1988) Pain syndromes in multiple sclerosis. Neurology 38(12):1830–1834. https://doi.org/10.1212/WNL.38.12.1830

    Article  CAS  PubMed  Google Scholar 

  35. Archibald CJ, McGrath PJ, Ritvo PG, Fisk JD, Bhan V, Maxner CE, Murray TJ (1994) Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients. Pain 58(1):89–93. https://doi.org/10.1016/0304-3959(94)90188-0

    Article  CAS  PubMed  Google Scholar 

  36. Beiske AG, Pedersen ED, Czujko B, Myhr K-MM (2004) Pain and sensory complaints in multiple sclerosis. Eur J Neurol 11(7):479–482. https://doi.org/10.1111/j.1468-1331.2004.00815.x

    Article  CAS  PubMed  Google Scholar 

  37. Grasso MG, Clemenzi A, Tonini A, Pace L, Casillo P, Cuccaro A, Pompa A, Troisi E (2008) Pain in multiple sclerosis: a clinical and instrumental approach. Mult Scler 14(4):506–513. https://doi.org/10.1177/1352458507085553

    Article  CAS  PubMed  Google Scholar 

  38. Rae-Grant ADD, Eckert NJJ, Bartz S, Reed JF (1999) Sensory symptoms of multiple sclerosis: a hidden reservoir of morbidity. Mult Scler 5(3):179–183. https://doi.org/10.1191/135245899678846032

    Article  CAS  PubMed  Google Scholar 

  39. Warnell P (1991) The pain experience of a multiple sclerosis population: a descriptive study. Axone 13(1):26–28

    CAS  PubMed  Google Scholar 

  40. Unruh AM Gender variations in clinical pain experience. Pain 65:123–167

  41. Truini A, Galeotti F, La Cesa S, di Rezze S, Biasiotta A, di Stefano G, Tinelli E, Millefiorini E, Gatti A, Cruccu G (2012) Mechanisms of pain in multiple sclerosis: a combined clinical and neurophysiological study. Pain 153(10):2048–2054. https://doi.org/10.1016/j.pain.2012.05.024

    Article  PubMed  Google Scholar 

  42. Holmes A, Christelis N, Arnold C (2013) Depression and chronic pain. Med J Aust 199(6 Suppl):S17–S20

    PubMed  Google Scholar 

  43. Dworkin RH, Jensen MP, Gammaitoni AR, Olaleye DO, Galer BS (2007) Symptom profiles differ in patients with neuropathic versus non-neuropathic pain. J Pain 8(2):118–126. https://doi.org/10.1016/j.jpain.2006.06.005

    Article  PubMed  Google Scholar 

  44. Solaro C, Messmer Uccelli M (2011) Management of pain in multiple sclerosis: a pharmacological approach. Nat Rev Neurol 7(9):519–527. https://doi.org/10.1038/nrneurol.2011.120

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neurology Unit, Department of Biomedical Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy

    Diana Ferraro, Franca Morselli, Anna M. Simone, Francesca Vitetta & Patrizia Sola

  2. S.O.C. Neurologia, Ospedale San Biagio, Piazza Vittime dei Lager Nazifascisti n.1, 28845, Domodossola, VB, Italy

    Domenico Plantone

  3. Psychology Unit, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy

    Giulia Dallari

  4. Neurology Institute, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy

    Guido Primiano, Viviana Nociti, Massimiliano Mirabella & Catello Vollono

  5. Fondazione Don C Gnocchi Onlus, Milan, Italy

    Viviana Nociti

  6. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy

    Matteo Pardini

  7. IRCCS IST S. Martino Hospital, Genoa, Italy

    Matteo Pardini

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  1. Diana Ferraro
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  2. Domenico Plantone
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Corresponding author

Correspondence to Domenico Plantone.

Ethics declarations

All study procedures were conducted according to the Declaration of Helsinki and were approved by the Modena ethics committee (protocol nr. 181/15). All enrolled subjects presented consent capacity and gave written informed consent to the study.

Conflict of interest

DP received the “Premio Anna Paola Batocchi” 2nd edition from Fondazione Cesare Serono. DF declares that there is no conflict of interest. FM declares that there is no conflict of interest. GD declares that there is no conflict of interest. AMS declares that there is no conflict of interest. FV declares that there is no conflict of interest. PS declares that there is no conflict of interest. GP declares that there is no conflict of interest. VN declares that there is no conflict of interest. MP declares that there is no conflict of interest. MM declares that there is no conflict of interest. CV declares that there is no conflict of interest.

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Ferraro, D., Plantone, D., Morselli, F. et al. Systematic assessment and characterization of chronic pain in multiple sclerosis patients. Neurol Sci 39, 445–453 (2018). https://doi.org/10.1007/s10072-017-3217-x

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