Skip to main content
SpringerLink
Log in

Identifying neuropathic pain in patients with multiple sclerosis: a cross-sectional multicenter study using highly specific criteria

Journal of Neurology volume 265, pages 828–835 (2018)Cite this article

Abstract

Background

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1
Fig. 2

References

  1. Compston A, Coles A (2008) Multiple sclerosis. Lancet 25(372):1502–1517

    Article  Google Scholar 

  2. Solaro C, Brichetto G, Amato MP et al (2004) The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study. Neurology 63(5):919–921

    Article  CAS  PubMed  Google Scholar 

  3. O’Connor AB, Schwid SR, Herrmann DN, Markman JD, Dworkin RH (2008) Pain associated with multiple sclerosis: systematic review and proposed classification. Pain 137:96–111

    Article  PubMed  Google Scholar 

  4. Truini A, Galeotti F, La Cesa S et al (2012) Mechanisms of pain in multiple sclerosis: a combined clinical and neurophysiological study. Pain 153(10):2048–2054

    Article  PubMed  Google Scholar 

  5. Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S et al (2013) Prevalence and natural history of pain in adults with multiple sclerosis: Systematic review and meta-analysis. Pain. 154(5):632–642

    Article  PubMed  Google Scholar 

  6. Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J (2008) Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 70(18):1630–1635

    Article  CAS  PubMed  Google Scholar 

  7. Finnerup NB, Haroutounian S, Kamerman P et al (2016) Neuropathic pain: an updated grading system for research and clinical practice. Pain. 157(8):1599–1606

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Cruccu G, Sommer C, Anand P, Attal N, Baron R, Garcia-Larrea L et al (2010) EFNS guidelines on neurophatic pain assessment: revised 2009. Eur J Neurol 17:1010–1018

    Article  CAS  PubMed  Google Scholar 

  9. Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E et al (2004) Development and validation of the Neurophatic Pain Symptom Inventorry. Pain 108:248–257

    Article  PubMed  Google Scholar 

  10. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A et al (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 114:29–36

    Article  PubMed  Google Scholar 

  11. Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C (2008) prevalence of chronic pain with neuropathic characteristics in the general population. Pain 136:380–387

    Article  PubMed  Google Scholar 

  12. Moisset X, Ouchchane L, Guy N, Bayle DJ, Dallel R, Clavelou P (2013) Migraine headaches and pain with neuropathic characteristics: comorbid conditions in patients with multiple sclerosis. Pain 154:2691–2699

    Article  PubMed  Google Scholar 

  13. Polman CH, Reingold SC, Banwell B et al (2010) Diagnostic oriteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011(69):292–302

    Google Scholar 

  14. Svendsen KB, Jensen TS, Overvad K et al (2003) Pain in patients with multiple sclerosis: a population-based study. Arch Neurol 60(8):1089–1094

    Article  PubMed  Google Scholar 

  15. Osterberg A, Boivie J, Thuomas KA (2005) Central pain in multiple sclerosis—prevalence and clinical characteristics. Eur J Pain 9(5):531–542

    Article  CAS  PubMed  Google Scholar 

  16. Svendsen KB, Sorensen L, Jensen TS, Hansen HJ, Bach FW (2011) MRI of the central nervous system in MS patients with or without pain. Eur J Pain 15(4):395–401

    Article  PubMed  Google Scholar 

  17. Hadjimichael O, Kerns RD, Rizzo MA et al (2007) Persistent pain and uncomfortable sensation in persons with multiple sclerosis. Pain 127(12):35–41

    Article  PubMed  Google Scholar 

  18. Tsang A, Von Korff M, Lee S et al (2008) Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression anxiety disorders. J Pain 9(10):883–891

    Article  PubMed  Google Scholar 

  19. Truini A, Barbanti P, Pozzilli C et al (2013) A mechanism-based classification of pain in multiple sclerosis. J Neurol 260(2):351–367

    Article  CAS  PubMed  Google Scholar 

  20. Brichetto G, Messmer Uccelli M, Mancardi GL, Solaro C (2003) Symptomatic medication use in multiple sclerosis. Mult Scler 9(5):458–460

    Article  CAS  PubMed  Google Scholar 

  21. Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G (2017) Trigeminal neuralgia—diagnosis and treatment. Cephalalgia Int J Headache 37(7):648–657

    Article  Google Scholar 

  22. Solaro C, Allemani C, Messmer Uccelli M, Canevari E, Dagnino N, Pizio R, Regesta G, Tanganelli P, Battaglia MA, Mancardi GL (2005) The prevalence of multiple sclerosis in the north-west Italian province of Genoa. J Neurol 252(4):436–440 (Epub 2005 Feb 23; PubMed PMID: 15726261)

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The study was partly supported by an investigator-initiated research grant from Pfizer.

Author information

Authors and Affiliations

  1. Department of Rehabilitation, Mons Luigi Novarese Novarese, Moncrivello, Italy

    Claudio Solaro

  2. Department of Neurology, ASL3 Genovese, Genoa, Italy

    M. Cella

  3. Section of Biostatistics, Department of Health Sciences, University of Genova, Genoa, Italy

    Alessio Signori

  4. Department of Neurology, San Raffaele Scientific Institute, Milan, Italy

    Vittorio Martinelli & Marta Radaelli

  5. Neurology Clinic, Department of Systems Medicine, Tor Vergata University, Rome, Italy

    D. Centonze & F. Sica

  6. Istituto Neurologico Mediterraneo Neuromed, IRCCS, Pozzilli (IS), Italy

    D. Centonze & F. Sica

  7. Santa Lucia Foundation, IRCCS, Rome, Italy

    M. G. Grasso & A. Clemenzi

  8. Clinic of Neurology, Second University of Naples, Naples, Italy

    S. Bonavita & S. Esposito

  9. Department of Neurosciences, University of Catania, Catania, Italy

    F. Patti & E. D’Amico

  10. Department of Neurology and Psychiatry, University of Rome-La Sapienza, Rome, Italy

    G. Cruccu & A. Truini

Authors
  1. Claudio Solaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Cella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessio Signori
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vittorio Martinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marta Radaelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Centonze
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. Sica
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. G. Grasso
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Clemenzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Bonavita
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. S. Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. F. Patti
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. E. D’Amico
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. G. Cruccu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. A. Truini
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Neuropathic Pain Special Interest Group of the Italian Neurological Society

Contributions

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.

Corresponding author

Correspondence to Claudio Solaro.

Ethics declarations

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.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Solaro, C., Cella, M., Signori, A. et al. Identifying neuropathic pain in patients with multiple sclerosis: a cross-sectional multicenter study using highly specific criteria. J Neurol 265, 828–835 (2018). https://doi.org/10.1007/s00415-018-8758-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-018-8758-2

Keywords

search

Navigation