Identifying neuropathic pain in patients with multiple sclerosis: a cross-sectional multicenter study using highly specific criteria
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Pain is a common and heterogeneous complication of multiple sclerosis (MS). In this multicenter, cross sectional study, we aimed at investigating the prevalence of pain in MS using highly specific criteria for distinguishing the different types of pain.
Materials and methods
After a structured interview, in patients with pain, clinical examination and DN4 questionnaire were used for distinguishing neuropathic and nociceptive pain. In subjects with neuropathic pain, the Neuropathic Pain Symptom Inventory was used for differentiating neuropathic pain symptoms.
We enrolled 1249 participants (832 F, 417 M, mean age 33.9 years, mean disease duration 8 years, mean EDSS 3.2); based on clinical evaluation and DN4 score 429 patients (34.34%) were classified with pain (470 pain syndromes): 286 nociceptive pain syndromes and 184 neuropathic pain syndromes. Multivariate analysis showed that pain was associated with age, gender and disease severity and that neuropathic pain was distinctly associated with EDSS.
Our study, providing definite information on the prevalence, characteristics and variables associated with neuropathic pain due to MS, shows that a more severe disease course is associated with a higher risk of neuropathic pain. Our findings might, therefore, provide a basis for improving the clinical management of this common MS complication.
KeywordsMultiple sclerosis Pain DN4 NPSI
The study was partly supported by an investigator-initiated research grant from Pfizer.
CS: Study concept and design, study supervision and interpretation of data. MC: Acquisition of data. AS: Analysis and interpretation of data. VM: Acquisition of data. MR: Acquisition of data. DC: Acquisition of data. Dr. Rossi: Acquisition of data. MGG: Acquisition of data. AC: Acquisition of data. SB: Acquisition of data. SE: Acquisition of data. FP: Acquisition of data. ED: Acquisition of data. GC: Study supervision and interpretation of data. AT: Study supervision and interpretation of data.
Compliance with ethical standards
Conflicts of interest
Dr. Solaro served on advisory boards of the following companies: Biogen Idec, Merck Serono. He received speaking honoraria from Bayer Schering, Biogen Idec, Merck Serono, Almirall, Teva, Genzyme. He received research grants and support from the Italian MS Society Research Foundation (Fondazione Italiana Sclerosi Multipla). Dr. Signori reported no disclosures. Dr. Martinelli reported no disclosures. Dr. Radaelli reported no disclosures. Dr. Centonze acted as an Advisory Board member of, and received funding for travelling and honoraria for speaking or consultation fees from Merck-Serono, Teva, Genzyme, Bayer Schering, Biogen Idec, Novartis, Almirall, GW Pharmaceuticals. He is the principal investigator in clinical trials for Novartis, Merck Serono, Teva, Bayer Schering, Sanofi-aventis, Biogen Idec, Roche. Dr. Grasso received research grants and support from the Italian MS Society Research Foundation (Fondazione Italiana Sclerosi Multipla). Dr. Clemenzi reported no disclosures. Dr. Bonavita received honoraria for advisory board and speaking activities from Biogen-Idec, Merck Serono, Teva and Novartis. Dr. D’Ambrosio reported no disclosures. Dr. Patti: received honoraria for advisory board and speaking activities from Almirall, Bayer, Biogen, Merck Serono, Novartis, Sanofi Genzyme and TEVA; he also received research grants from FISM and MIUR. Dr. D’Amico: reported no disclosures. Dr. Cruccu received honoraria for advisory board and speaking activities from Angelini, Biogen, Convergence, Mundipharma e Sigma Tau. Dr. Truini: received research funding, lecture honoraria and acted as speaker or consultant for Mundipharma, Pfizer, Grünenthal, Angelini Pharma, Sigma Tau.
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