Skip to main content
SpringerLink
Log in

Les douleurs au cours de la sclérose en plaques

  • Published:
Douleur et Analgésie

Résumé

La sclérose en plaques (SEP) s'accompagne fréquemment de douleurs. Certaines sont liées directement au processus lésionnel et de mécanismes neurogène, d'autres sont les conséquences indirectes de la maladie. Ces douleurs aggravent le handicap de ces patients en particulier sur le plan profesionnel. La prise en charge des douleurs de la SEP nécessite dans un premier temps de déterminer le(s) mécanisme(s) de la douleur (neurogènes paroxystiques et continues; crises toniques; douleurs des poussées; spasticité (contractures), ou douleurs secondaires (lombalgies, douleurs, coliques, etc.) et enfin les douleurs iatrogènes. La deuxième étape consiste à administrer un traitement adapté à ce(s) mécanisme(s) et à prendre en charge les facteurs associés. Le traitement des douleurs neurogènes paroxystique repose sur les antiépileptiques. La carbamazépine est utilisée en première intention. Le clonazépam est très utile en cas de crises nocturnes. La gabapentine et d'autres anti-comitiaux ont été proposés récemment dans cette indication. Le traitement des douleurs neurogènes continues par les tricycliques est souvent décevant et pose des problèmes spécifiques liés aux troubles vésicaux. Une approche globale est nécessaire. Les crises toniques douloureuses sont traitées essentiellement par les anti-comitiaux. Les douleurs des poussées sont traitées par le traitement corticoïdes de la poussée. Les douleurs liées à la spasticité peuvent nécessiter le recours au baclofène intrathécal en cas d'échec des antispastiques. Les douleurs iatrogènes peuvent être évitées dans certains cas par une prévention spécifique (douleurs des ponctions lombaires, douleurs aux points d'injection des traitements par interféron).

Summary

Pain is common during multiple sclerosis (MS). In most cases pain is secondary to the pathophysiological process of MS and is a neuropathic central pain. Secondary pain is also possible, due to other disabilities. Pain may contribute to work limitations in MS. Management of pain during MS needs an accurate diagnosis of the type of pain and of the underlying mechanisms: paroxystic neuropathic pain, continuous neuropathic pain, painful spasms, spasticity or secondary pain like low back pain, bowel pain and, lastly, iatrogenic pain. Anti-epileptic drugs are helpful in the management of paroxysmal pain, like trigeminal neuralgia or painful spasms, including carbamazepine and gabapentin. They are sometimes also useful to treat continuous chronic central pain but tricyclic antide-pressant and opioids are often required. Pain during relapses maybe alleviated by steroids and iatrogenic pain may be avoided by appropriate management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Bibliographie

  1. Aidi S., Chaunu M.P., Biousse V. andBousser M.G.: Changing pattern of headache pointing to cerebral venous thrombosis after lumbar puncture and intravenous high-dose corticosteroids.Headache 39, 559–564, 1999.

    Article  PubMed  CAS  Google Scholar 

  2. Archibald C.J., McGrath P.J., Ritvo P.G., Fisk J.D., Bhan V., Maxner C.E. andMurray T.J.: Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients.Pain 58, 89–93, 1994.

    Article  PubMed  CAS  Google Scholar 

  3. Arnoldus J.H., Killestein J., Pfennings L.E., Jelles B., Uitdehaag B.M. andPolman C.H.: Quality of life during the first 6 months of interferon beta treatment in patients with MS.Mult. Scler. 6, 338–342, 2000.

    PubMed  CAS  Google Scholar 

  4. Backonja M., Beydoun A., Edwards K.R., Schwartz S.L., Fonseca V., Hes M., LaMoreaux L. andGarofalo E.: Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial.JAMA 280, 1831–1836, 1998.

    Article  PubMed  CAS  Google Scholar 

  5. Bentley P.I., Kimber T. andSchapira A.H.V.: Painful third nerve palsy in MS.Neurology 58, 1532, 2002.

    PubMed  CAS  Google Scholar 

  6. Brochet B.: Les douleurs centrales.In: Brasseur L., Chauvin M., Guilbaud G., eds.Douleurs. Paris: Maloine, 447–63, 1997.

    Google Scholar 

  7. Brochet B.: Aspects cliniques, physiopathologiques et thérapeutiques de la sclérose en plaques.Encycl. Méd. Chir. (Paris, France), Neurologie, 17-074B-10. 2001.

  8. Brochet B.: Indications thérapeutiques lors des poussées de sclérose en plaques.Rev. Neurol. (Paris) 157, 988–995, 2001.

    CAS  Google Scholar 

  9. Brochet B.: Stratégie face à une douleur chronique.In CNEUD, CNMD SFAP, eds.Douleurs aiguës, Douleurs chroniques, soins palliatifs. Paris, Medline, 189–208, 2001.

    Google Scholar 

  10. Brochet B., Michel P. andHenry P.: Pain complaints in outpatients with multiple sclerosis: description and consequences on disability.The Pain Clinic 5, 157–163, 1992.

    Google Scholar 

  11. Broggi G., Ferroli P., Franzini A., Servello D. andDones I.: Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis.J. Neurol. Neurosurg. Psychiatry 68, 59–64, 2000.

    Article  PubMed  CAS  Google Scholar 

  12. Clifford D.B. andTrotter J.L.: Pain in multiple sclerosis.Arch. Neurol. 41, 1270–1272, 1984.

    PubMed  CAS  Google Scholar 

  13. Deloire-Grassin M., Ouallet J.C., Salort E., Barosso B., Brochet B. andthe AQUISEP network: Quality of life, disability and depression in early MS.Mult. Scler. 8 (suppl. 1), S73, 2002.

    Google Scholar 

  14. De Sèze M., Wiart L., De Sèze M.P., Joseph P.A., Brochet B., Ferriere J.M., Mazaux J.M. etBarat M.: Capasaïcine intravésicale et hyper-réflexie du detrusor. Expérience de 100 instillations sur une période de cinq ans.Ann. Réadapt. Med. Phys. 44, 514–524, 2001.

    PubMed  Google Scholar 

  15. Gass A., Kitchen N., MacManus D.G., Moseley I.F., Hennerici M.G. andMiller D.H.: Trigeminal neuralgia in patients with multiple sclerosis: lesion localization with magnetic resonance imaging.Neurology 49, 1142–1144, 1997.

    PubMed  CAS  Google Scholar 

  16. Gottberg K., Gardulf A. andFredrikson S.: Interferon-beta treatment for patients with multiple sclerosis: the patients' perceptions of the side effects.Mult. Scler. 6, 349–354, 2000.

    PubMed  CAS  Google Scholar 

  17. Heinzerling L., Dummer R., Burg G. andSchmid-Grendelmeir P.: Panniculitis after subcutaneous injection of interferon-beta in a multiple sclerosis patient.Eur. J. Dermatol. 12, 194–197, 2002.

    PubMed  Google Scholar 

  18. Hooge J.P. andRedekop W.K.: Trigeminal neuralgia in multiple sclerosis.Neurology 45, 1294–1296, 1995.

    PubMed  CAS  Google Scholar 

  19. Houtchens M.K., Richert J.R., Sami A. andRose J.W.: Open label gabapentin treatment for pain in multiple sclerosis.Mult. Scler. 3, 250–253, 1997.

    Article  PubMed  CAS  Google Scholar 

  20. Hyman N., Barnes M., Bhakta B., Cozens A., Bakheit M., Kreczy-Kleedorfer B., Poewe W., Wissel J., Bain P., Glickman S., Sayer A., Richardson A. andDott C.: Botulinium toxin (Dysport) treatment of hip adductor spasticity in multiple sclerosis: a prospective, randomised, double blind, placebo controlled, dose ranging study.J. Neurol. Neurosurg. Psychiatry 68, 707–712, 2000.

    Article  PubMed  CAS  Google Scholar 

  21. Indaco A., Iachetta C., Nappi C., Socci L. andCarrieri P.B.: Chronic and acute pain syndromes in patients with multiple sclerosis.Acta Neurol. (Napoli) 16, 97–102, 1994.

    CAS  Google Scholar 

  22. Kalman S., Osterberg A. Sorensen J., Boivie J. andBertler A.: Morphine responsiveness in a group of well-defined multiple sclerosis patients: a study with i.v. morphine.Eur. J. Pain 6, 69–80, 2002.

    Article  PubMed  CAS  Google Scholar 

  23. Kanpolat Y. Berk C., Savas A. andBekar A.: Percutaneous controlled radiofraquency rhizotomy in the management of patients with trigeminal neuralgia due to multiple sclerosis.Acta Neurochir. (Wien) 142, 685–689, 2000.

    Article  CAS  Google Scholar 

  24. Khan O.A.: Gabapentin relieves trigeminal neuralgia in multiple sclerosis patients.Neurology 51, 611–614, 1998.

    PubMed  CAS  Google Scholar 

  25. Killestein J., Hoogervorst E.L., Reif M., Kalkers N.F., Van Loenen A.C., Staats P.G., Gorter R.W., Uitdehaag B.M. andPolman C.H.: Safety, tolerability and efficacy of orally administered cannabinoids in MS.Neurology 58, 1404–1407, 2002.

    PubMed  CAS  Google Scholar 

  26. Kumar K., Toth C., Nath R.K. andLaing P.: Epidural spinal cord stimulation for treatment of chronic pain-some predictors of success. A 15-year experience.Surg. Neurol. 50, 110–120, 1998.

    Article  PubMed  CAS  Google Scholar 

  27. Leandri M., Lunardi G., Inglese M., Messmer-Ucelli M., Mancardi G.L., Gottlieb A. andSolaro C.: Lamotrigine in trigeminal neuralgia secondary to multiple sclerosis.J. Neurol. 247, 556–558, 2000.

    Article  PubMed  CAS  Google Scholar 

  28. Leijon G. andBoivie J.: Central post-stroke pain- a controlled trial of amitryptiline and carbamazepine.Pain 36, 27–36, 1989.

    Article  PubMed  CAS  Google Scholar 

  29. Love S., Gradidge T. andCoakham H.B.: Trigeminal neuralgia due to multiple sclerosis: ultrastructural findings in trigeminal rhizotomy specimens.Neuropathol. Appl. Neurobiol. 27, 238–244, 2001.

    Article  PubMed  CAS  Google Scholar 

  30. Lunardi G., Leandri M., Albano C., Cultrera S., Fracassi M., Rubino V. andFavale E.: Clinical effectiveness of lamotrigine and plasma levels in essential and symptomatic trigeminal neuralgia.Neurology 48, 1714–1717, 1997.

    PubMed  CAS  Google Scholar 

  31. McQuay H.J. andMoore R.A.: Antidepressants and chronic pain.B.M.J. 314, 763–764, 1997.

    CAS  Google Scholar 

  32. Meaney J.F., Watt J.W., Eldridge P.R., Whitehouse G.H., Wells J.C. andMiles J.B.: Association between trigeminal neuralgia and multiple sclerosis: role of magnetic resonance imaging.J. Neurol. Neurosurg. Psychiatry 59, 253–259, 1995.

    Article  PubMed  CAS  Google Scholar 

  33. Minagar A. andSheremata W.A.: Glossopharyngeal neuralgia and MS.Neurology 54, 1368–1370, 2000.

    PubMed  CAS  Google Scholar 

  34. Moulin D.E., Foley K.M. andEbers G.C.: Pain syndromes in multiple sclerosis.Neurology 38, 1830–1834, 1988.

    PubMed  CAS  Google Scholar 

  35. Patterson V., Watt M., Byrnes D., Crowe D. andLee A.: Management of severe spasticity with intrathecal bacllofen delivered by a manually operated pump.J. Neurol. Neurosurg. Psychiatry 57, 582–585, 1994.

    Article  PubMed  CAS  Google Scholar 

  36. Ramirez-Lassepas M., Tulloch J.W., Quinones M.R. andSnyder B.D.: Acute radicular pain as a presenting symptom in multiple sclerosis.Arch. Neurol. 49, 255–258, 1992.

    PubMed  CAS  Google Scholar 

  37. Ramsaransing G., Zwanikken C. andDe Keyser J.: Worsening of symptoms of multiple sclerosis associated with carbamazepine.B.M.J. 320, 113, 2000.

    Article  Google Scholar 

  38. Rowbotham M., Harden N., Stacey B., Bernstein P. andMagnus-Miller L.: Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial.JAMA 280, 1837–1842, 1998.

    Article  PubMed  CAS  Google Scholar 

  39. Sakurai M. andKanazawa I.: Positive symptoms in multiple sclerosis: their treatment with sodium channel blockers, lidocaïne and mexiletine.J. Neurol. Sci. 162, 162–168, 1999.

    Article  PubMed  CAS  Google Scholar 

  40. Salort E., Deloire-Grassin M.S.A., Boudineau M., Ouallet J.C., Baroso B., Arese P., Verley C., Fabrigoule C., Leteneur L. andBrochet B.: Cognitive performances are altered in early multiple sclerosis.Mult. Scler. 8(suppl 1), S106-S107, 2002.

    Google Scholar 

  41. Sindrup S.H., Andersen G., Madsen C., Smith T., Brosen K. andJensen T.S.: Tramadol relieves pain and allodynia in polyneuropathy: a randomised, double-blind, controlled trial.Pain 83, 85–90, 1999.

    Article  PubMed  CAS  Google Scholar 

  42. Solaro C., Lunardi G.L., Capello E., Inglese M., Messmer-Uccelli M., Uccelli A. andMancardi G.L.: An open-label trial of gabapentin treatment of paroxysmal symptoms in multiple sclerosis patients.Neurology 51, 609–611, 1998.

    PubMed  CAS  Google Scholar 

  43. Solaro C., Messmer-Uccelli M., Uccelli A., Leandri M. andMancardi G.L.: Low-dose gabapentin combined with either lamotrigine or carbamazepine can be useful therapies for trigeminal neuralgia in multiple sclerosis.Eur. Neurol. 44, 45–48, 2000.

    Article  PubMed  CAS  Google Scholar 

  44. Solaro C., Messmer-Uccelli M., Guglieri P., Uccelli A. andMancardi G.L.: Gabapentin is effective in treating nocturnal painful spasms in multiple sclerosis.Mult. Scler. 6, 192–193, 2000.

    PubMed  CAS  Google Scholar 

  45. Spissu A., Cannas A., Ferrigno P., Pelaghi A.E. andSpissu M.: Anatomic correlates of painful tonic spasms in multiple sclerosis.Mov. Disord. 14, 331–335, 1999.

    Article  PubMed  CAS  Google Scholar 

  46. Stenager E., Knudsen L. andJensen K.: Acute and chronic pain syndromes in multiple sclerosis.Acta Neurol. Scand. 84, 197–200, 1991.

    PubMed  CAS  Google Scholar 

  47. Stenager E., Knudsen L. andJensen K.: Acute and chronic pain syndromes in multiple sclerosis; A 5-year follow-up study.Ital. J. Neurol. Sci. 16, 629–632, 1995.

    Article  PubMed  CAS  Google Scholar 

  48. Vernay D., Gerbaud L., Biolay S., Coste J., Debourse J., Aufauvre D., Beneton C., Colamarino R., Glanddier P.Y., Dordain G. etClavelou P.: Qualité de vie et sclérose en plaques: validation de la version française d'un auto questionnaire (SEP-59).Rev. Neurol. (Paris) 156, 247–263, 2000.

    CAS  Google Scholar 

  49. Vestergaard K., Andersen G., Gottrup H., Kristensen B.T. andJensen T.S.: Lamotrigine for central poststroke pain: a randomized controlled trial.Neurology 56, 184–190, 2001.

    PubMed  CAS  Google Scholar 

  50. Warnell P.: The pain experience of a multiple sclerosis population: a descriptive study.Axone 1, 26–28, 1991.

    Google Scholar 

  51. Zvartau-Hind M., Din M.U., Gilani A., Lisak R.P. andKhan O.A.: Topiramate relieves refractory trigeminal neuralgia in MS patients.Neurology 55, 1587–1588, 2000.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinique de la SEP et Unité de Traitement des Douloureux Chroniques, Service de Neurologie B, Fédération des Neurosciences cliniques, CHU Pellegrin, F-33076, Bordeaux Cedex

    B. Brochet

Authors
  1. B. Brochet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Brochet.

About this article

Cite this article

Brochet, B. Les douleurs au cours de la sclérose en plaques. Doul. et Analg. 16, 213–219 (2003). https://doi.org/10.1007/BF03014223

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03014223

Mots-clés

Key-words

Search

Navigation