Diagnosis and treatment of pain in patients with multiple sclerosis

Abstract:

Pain is not one of the leading symptoms for the diagnosis of multiple sclerosis (MS), however when it appears it can become a big problem for patients due to its decisive influence on the quality of life. Although epidemiological data vary, it is estimated that more than 50% of patients with MS suffer from some kind of pain. In MS, the pain can be divided according to the pathogenesis in neuropathic and nociceptive. Some authors would add the dysfunctional type of pain that is an expression of the pathological processing of pain impulses without anatomical lesions of nerve structure and nociceptors stimuli. It is considered that there are several pathophysiological mechanisms working in the same patient, but the most important would be pathological central sensitization as a result of the pathological reorganization of the somatosensory pathways which is caused by the processes of deafferentation. Therapy for neuropathic pain in multiple sclerosis is not specific, and it is based on the fundamental principles of the neuropathic pain treatment. The favored drugs for treatment are pregabalin, gabapentin and tricyclic antidepressants, but there are many reports on exogenous cannabinoids being an efficient alternative in treating neuropathic pain in MS. Painful spasms can be treated by the drugs such as diazepam, baclofen and tizanidine. Botulin toxin is reported to be very successful in treating painful spasticity. 

Key words:
multiple sclerosis; neuropathic pain; nociceptive pain; therapy