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Guillain-Barré syndrome pain.
Last reviewed: 04.07.2025
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Pain in Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculoneuropathy) develops in 89% of patients. Clinically, there are 2 types of pain in this disease. The first type is aching pain in the back and legs, the severity of which correlates with muscle weakness. Pain can be localized in the gluteal region, along the anterior and posterior surfaces of the thighs on both sides. Passive movements in the affected muscles contribute to increased pain. The second type is constant burning pain, accompanied by paresthesia and hyperesthesia. The first type of pain is probably associated with inflammation and compression of the nerve roots, the second - with dysfunction of the demyelinated sensory nerves and the occurrence of spontaneous discharges in them. Nevertheless, the pathophysiological mechanisms of pain in Guillain-Barré syndrome have not yet been sufficiently studied. It is suggested that demyelination of thick (well myelinated) and thin (poorly myelinated) sensory fibers disrupts the physiological balance between nociceptive (through thin fibers) and antinociceptive (through thick fibers) impulses entering the dorsal horn. These mechanisms partially explain the low efficacy of NSAIDs and opioids in patients with Guillain-Barré syndrome. This is why anticonvulsants have been used in the treatment of pain in Guillain-Barré syndrome. Two short-term randomized trials have examined the efficacy of gabapentin in the acute stage of the disease in comparison with placebo and carbamazepine, as well as with the use of opioids on demand. In one study, gabapentin was more effective than placebo and allowed a decrease in the frequency of opioid intake. In the other study, gabapentin was found to be more effective than carbamazepine.
Based on a systematic review of data on pain management in Guillain-Barré syndrome, it has been suggested that carbamazepine or gabapentin should be used to relieve pain in the acute phase of the disease. The use of opioids should be limited due to side effects that are particularly common in patients with Guillain-Barré syndrome (probably due to the autonomic dysfunction typical of this disease).
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