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Pain in Multiple Sclerosis
Last reviewed: 23.04.2024
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Pain occurs in 56% of patients with multiple sclerosis, and in almost a third of cases they are neuropathic. In 87% of cases, the pain is localized in the lower limbs, in 31% - grasping hands. Bilateral pain is observed in 76% of cases. In 88% of pain, constant, painful paroxysms are noted only in 2% of cases. The most typical acute, burning, stitching pain, usually quite intense. In 98% of cases, pains are combined with other sensory disorders (increased sensitivity to mechanical and temperature stimuli). Neuralgia of the trigeminal nerve with multiple sclerosis is observed in 4-5% of cases (it is usually associated with demyelination of the roots of the trigeminal nerve). Very characteristic of multiple sclerosis dysesthesia. In general, one third of patients call pain the most severe symptom of their disease, which significantly worsens the quality of life.
Neuropathic pain in multiple sclerosis is associated with the lesion of the dorsal-thalamic tract, deafferentation, a violation of the descending control of pain.
Treatment of pain in multiple sclerosis. To relieve the neuropathic pain syndrome with multiple sclerosis, amitriptyline, lamotrigine, carbamazepine, gabapentin, lopiramate are used, although there have not been large-scale evidence-based studies of the efficacy of these drugs. All researchers unanimously acknowledge the need for well-organized controlled trials of pharmacological drugs for the treatment of pain in these patients.
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