A mechanism-based classification of pain in multiple sclerosis

A. Truini, P. Barbanti, C. Pozzilli, G. Cruccu

Research output: Contribution to journalArticlepeer-review

Abstract

Pharmacological treatment of pain in multiple sclerosis (MS) is challenging due to the many underlying pathophysiological mechanisms. Few controlled trials show adequate pain control in this population. Emerging evidence suggests that pain might be more effectively classified and treated according to symptoms and underlying mechanisms. The new mechanism-based classification we propose here distinguishes nine types of MS-related pain: trigeminal neuralgia and Lhermitte's phenomenon (paroxysmal neuropathic pain due to ectopic impulse generation along primary afferents), ongoing extremity pain (deafferentation pain secondary to lesion in the spino-thalamo-cortical pathways), painful tonic spasms and spasticity pain (mixed pains secondary to lesions in the central motor pathways but mediated by muscle nociceptors), pain associated with optic neuritis (nerve trunk pain originating from nervi nervorum), musculoskeletal pains (nociceptive pain arising from postural abnormalities secondary to motor disorders), migraine (nociceptive pain favored by predisposing factors or secondary to midbrain lesions), and treatment-induced pains. Identification of various types of MS-related pain will allow appropriate targeted pharmacological treatment and improve clinical practice.

Original languageEnglish
Pages (from-to)351-367
Number of pages17
JournalJournal of Neurology
Volume260
Issue number2
DOIs
Publication statusPublished - Feb 2013

Keywords

  • Migraine
  • Multiple sclerosis
  • Neuropathic pain
  • Pain prevalence
  • Spasticity
  • Treatment trial

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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