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Neurological Sciences

, Volume 39, Issue 3, pp 445–453 | Cite as

Systematic assessment and characterization of chronic pain in multiple sclerosis patients

  • Diana Ferraro
  • Domenico PlantoneEmail author
  • Franca Morselli
  • Giulia Dallari
  • Anna M. Simone
  • Francesca Vitetta
  • Patrizia Sola
  • Guido Primiano
  • Viviana Nociti
  • Matteo Pardini
  • Massimiliano Mirabella
  • Catello Vollono
Original Article

Abstract

Pain is one of the most disabling clinical symptoms in patients with multiple sclerosis (MS). Several studies have already assessed the prevalence of pain in MS patients, reporting variable results, probably due to methodological differences. The aim of this single-centre cross-sectional study was to define the prevalence and characteristics of chronic pain in a population of MS patients using validated tools, and to analyse these data in relation to demographic and clinical features, including disease duration and disability (EDSS and its single functional system scores). Of 397 enrolled patients, 23 were excluded due to a Beck’s Depression Inventory Score > 19. In the remaining 374 patients, the overall prevalence of chronic pain was 52.1%, most frequently affecting the lower limbs (36.9%). Neuropathic pain was the most frequent type of chronic pain (89 patients, overall prevalence of 23.7%) and was associated with a sensory functional system involvement. Pain intensity was significantly higher in patients with neuropathic pain as opposed to patients with non-neuropathic pain. Patients with chronic pain and, in particular, patients with neuropathic pain had significantly higher EDSS scores than those without pain. Only 24% of patients with chronic pain and 33% of patients with neuropathic pain were on a specific long-lasting treatment for pain. The present study supports the routine assessment of neuropathic pain in MS patients, especially in those with a sensory functional system involvement, in order to avoid underdiagnosing and undertreating a potentially disabling condition.

Keywords

Pain Multiple sclerosis Neuropathic symptoms Pain treatment 

Notes

Compliance with ethical standards

All study procedures were conducted according to the Declaration of Helsinki and were approved by the Modena ethics committee (protocol nr. 181/15). All enrolled subjects presented consent capacity and gave written informed consent to the study.

Conflict of interest

DP received the “Premio Anna Paola Batocchi” 2nd edition from Fondazione Cesare Serono. DF declares that there is no conflict of interest. FM declares that there is no conflict of interest. GD declares that there is no conflict of interest. AMS declares that there is no conflict of interest. FV declares that there is no conflict of interest. PS declares that there is no conflict of interest. GP declares that there is no conflict of interest. VN declares that there is no conflict of interest. MP declares that there is no conflict of interest. MM declares that there is no conflict of interest. CV declares that there is no conflict of interest.

References

  1. 1.
    Clifford DB, Trotter JL (1984) Pain in multiple sclerosis. Arch Neurol 41(7):1270–1272.  https://doi.org/10.1212/WNL.39.7.1001 CrossRefPubMedGoogle Scholar
  2. 2.
    Kalia LV, O’Connor PW (2005) Severity of chronic pain and its relationship to quality of life in multiple sclerosis. Mult Scler 11(3):322–327.  https://doi.org/10.1191/1352458505ms1168oa CrossRefPubMedGoogle Scholar
  3. 3.
    Khan F, Pallant J (2007) Chronic pain in multiple sclerosis: prevalence, characteristics, and impact on quality of life in an Australian community cohort. J Pain 8(8):614–623.  https://doi.org/10.1016/j.jpain.2007.03.005 CrossRefPubMedGoogle Scholar
  4. 4.
    Martinelli Boneschi F, Colombo B, Annovazzi P, Martinelli V, Bernasconi L, Solaro C, Comi G (2008) Lifetime and actual prevalence of pain and headache in multiple sclerosis. Mult Scler 14(4):514–521.  https://doi.org/10.1177/1352458507085551 CrossRefPubMedGoogle Scholar
  5. 5.
    Moulin DE (1989) Pain in multiple sclerosis. Neurol Clin 7(2):321–331PubMedGoogle Scholar
  6. 6.
    Solaro C, Trabucco E, Messmer Uccelli M (2013) Pain and multiple sclerosis: pathophysiology and treatment. Curr Neurol Neurosci Rep 13(1):320.  https://doi.org/10.1007/s11910-012-0320-5 CrossRefPubMedGoogle Scholar
  7. 7.
    Hirsh AT, Turner AP, Ehde DM, Haselkorn JK (2009) Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors. Arch Phys Med Rehabil 90(4):646–651.  https://doi.org/10.1016/j.apmr.2008.10.019 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT (2013) Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis. Pain 154(5):632–642.  https://doi.org/10.1016/j.pain.2012.12.002 CrossRefPubMedGoogle Scholar
  9. 9.
    O’Connor AB, Schwid SR, Herrmann DN, Markman JD, Dworkin RH (2008) Pain associated with multiple sclerosis: systematic review and proposed classification. Pain 137(1):96–111.  https://doi.org/10.1016/j.pain.2007.08.024
  10. 10.
    Campbell JN, Meyer RA (2006) Mechanisms of neuropathic pain. Neuron 52(1):77–92.  https://doi.org/10.1016/j.neuron.2006.09.021 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Scholz J, Woolf CJ (2002) Can we conquer pain? Nat Neurosci 5(Supp):1062–1067.  https://doi.org/10.1038/nn942 CrossRefPubMedGoogle Scholar
  12. 12.
    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.  https://doi.org/10.1212/01.wnl.0000282763.29778.59 CrossRefPubMedGoogle Scholar
  13. 13.
    Turk DC, Okifuji A (2001) Pain terms and taxonomies. In: Loeser D, Butler SH, Chapman JJ, Turk DC (eds) Bonica’s Manag. Pain, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 18–25Google Scholar
  14. 14.
    Main CJ, Spanswick CC (2000) Pain management: an interdisciplinary approach. Churchill Livingstone, LondonGoogle Scholar
  15. 15.
    Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D (2006) Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 10(4):287–333.  https://doi.org/10.1016/j.ejpain.2005.06.009 CrossRefPubMedGoogle Scholar
  16. 16.
    Merskey H, Bogduk N (1994) Classification of chronic pain. IASP Pain Terminol 57(3):425–429.  https://doi.org/10.1002/ana.20394 Google Scholar
  17. 17.
    Truini A, Barbanti P, Pozzilli C, Cruccu G (2013) A mechanism-based classification of pain in multiple sclerosis. J Neurol 260(2):351–367.  https://doi.org/10.1007/s00415-012-6579-2 CrossRefPubMedGoogle Scholar
  18. 18.
    Chopra K, Arora V (2014) An intricate relationship between pain and depression: clinical correlates, coactivation factors and therapeutic targets. Expert Opin Ther Targets 18(2):159–176.  https://doi.org/10.1517/14728222.2014.855720 CrossRefPubMedGoogle Scholar
  19. 19.
    Hadjimichael O, Kerns RD, Rizzo MA, Cutter G, Vollmer T (2007) Persistent pain and uncomfortable sensations in persons with multiple sclerosis. Pain 127(1):35–41.  https://doi.org/10.1016/j.pain.2006.07.015 CrossRefPubMedGoogle Scholar
  20. 20.
    Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS (1997) Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 13(2):116–137.  https://doi.org/10.1097/00002508-199706000-00006 CrossRefPubMedGoogle Scholar
  21. 21.
    Alschuler KN, Ehde DM, Jensen MP (2013) Co-occurring depression and pain in multiple sclerosis. Phys Med Rehabil Clin N Am 24(4):703–715.  https://doi.org/10.1016/j.pmr.2013.06.001 CrossRefPubMedGoogle Scholar
  22. 22.
    Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33(11):1444–1452.  https://doi.org/10.1212/WNL.33.11.1444 CrossRefPubMedGoogle Scholar
  23. 23.
    Stenager E, Knudsen L, Jensen K (1995) Acute and chronic pain syndromes in multiple sclerosis. A 5-year follow-up study. Ital J Neurol Sci 16(8):629–632.  https://doi.org/10.1007/BF02230913 CrossRefPubMedGoogle Scholar
  24. 24.
    Heitmann H, Biberacher V, Tiemann L, Buck D, Loleit V, Selter RC, Knier B, Tölle TR, Mühlau M, Berthele A, Hemmer B, Ploner M (2015) Prevalence of neuropathic pain in early multiple sclerosis. Mult Scler J 22(9):8–11.  https://doi.org/10.1177/1352458515613643 Google Scholar
  25. 25.
    Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302.  https://doi.org/10.1002/ana.22366 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Ohayon MM, Stingl JC (2012) Prevalence and comorbidity of chronic pain in the German general population. J Psychiatr Res 46(4):444–450.  https://doi.org/10.1016/j.jpsychires.2012.01.001 CrossRefPubMedGoogle Scholar
  27. 27.
    Blyth FM, March LM, Brnabic AJM, Jorm LR, Williamson M, Cousins MJ (2001) Chronic pain in Australia: a prevalence study. Pain 89(2):127–134.  https://doi.org/10.1016/S0304-3959(00)00355-9 CrossRefPubMedGoogle Scholar
  28. 28.
    Caraceni A, Mendoza TR, Mencaglia E, Baratella C, Edwards K, Forjaz MJ, Martini C, Serlin RC, de Conno F, Cleeland CS (1996) A validation study of an Italian version of the Brief Pain Inventory (Breve Questionario per la Valutazione del Dolore). Pain 65(1):87–92.  https://doi.org/10.1016/0304-3959(95)00156-5 CrossRefPubMedGoogle Scholar
  29. 29.
    De Benedittis G, Massei R, Nobili R, Pieri A (1988) The Italian pain questionnaire. Pain 33(1):53–62.  https://doi.org/10.1016/0304-3959(88)90203-5 CrossRefPubMedGoogle Scholar
  30. 30.
    Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, Rostaing S, Lanteri-Minet M, Collin E, Grisart J, Boureau F (2004) Development and validation of the Neuropathic Pain Symptom Inventory. Pain 108(3):248–257.  https://doi.org/10.1016/j.pain.2003.12.024 CrossRefPubMedGoogle Scholar
  31. 31.
    Spallone V, Morganti R, D’Amato C, Greco C, Cacciotti L, Marfia GA (2012) Validation of DN4 as a screening tool for neuropathic pain in painful diabetic polyneuropathy. Diabet Med 29(5):578–585.  https://doi.org/10.1111/j.1464-5491.2011.03500.x CrossRefPubMedGoogle Scholar
  32. 32.
    Padua L, Briani C, Jann S, Nobile-Orazio E, Pazzaglia C, Morini A, Mondelli M, Ciaramitaro P, Cavaletti G, Cocito D, Fazio R, Santoro L, Galeotti F, Carpo M, Plasmati R, Benedetti L, Schenone A, Marchettini P, Cruccu G (2009) Validation of the Italian version of the Neuropathic Pain Symptom Inventory in peripheral nervous system diseases. Neurol Sci 30(2):99–106.  https://doi.org/10.1007/s10072-009-0025-y CrossRefPubMedGoogle Scholar
  33. 33.
    Beck AT, Ward CH, Mendelson M et al (1961) An inventory for measuring depression. Arch Gen Psychiatry 4(6):561–571.  https://doi.org/10.1001/archpsyc.1961.01710120031004 CrossRefPubMedGoogle Scholar
  34. 34.
    Moulin DE, Foley KM, Ebers GC (1988) Pain syndromes in multiple sclerosis. Neurology 38(12):1830–1834.  https://doi.org/10.1212/WNL.38.12.1830 CrossRefPubMedGoogle Scholar
  35. 35.
    Archibald CJ, McGrath PJ, Ritvo PG, Fisk JD, Bhan V, Maxner CE, Murray TJ (1994) Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients. Pain 58(1):89–93.  https://doi.org/10.1016/0304-3959(94)90188-0 CrossRefPubMedGoogle Scholar
  36. 36.
    Beiske AG, Pedersen ED, Czujko B, Myhr K-MM (2004) Pain and sensory complaints in multiple sclerosis. Eur J Neurol 11(7):479–482.  https://doi.org/10.1111/j.1468-1331.2004.00815.x CrossRefPubMedGoogle Scholar
  37. 37.
    Grasso MG, Clemenzi A, Tonini A, Pace L, Casillo P, Cuccaro A, Pompa A, Troisi E (2008) Pain in multiple sclerosis: a clinical and instrumental approach. Mult Scler 14(4):506–513.  https://doi.org/10.1177/1352458507085553 CrossRefPubMedGoogle Scholar
  38. 38.
    Rae-Grant ADD, Eckert NJJ, Bartz S, Reed JF (1999) Sensory symptoms of multiple sclerosis: a hidden reservoir of morbidity. Mult Scler 5(3):179–183.  https://doi.org/10.1191/135245899678846032 CrossRefPubMedGoogle Scholar
  39. 39.
    Warnell P (1991) The pain experience of a multiple sclerosis population: a descriptive study. Axone 13(1):26–28PubMedGoogle Scholar
  40. 40.
    Unruh AM Gender variations in clinical pain experience. Pain 65:123–167Google Scholar
  41. 41.
    Truini A, Galeotti F, La Cesa S, di Rezze S, Biasiotta A, di Stefano G, Tinelli E, Millefiorini E, Gatti A, Cruccu G (2012) Mechanisms of pain in multiple sclerosis: a combined clinical and neurophysiological study. Pain 153(10):2048–2054.  https://doi.org/10.1016/j.pain.2012.05.024 CrossRefPubMedGoogle Scholar
  42. 42.
    Holmes A, Christelis N, Arnold C (2013) Depression and chronic pain. Med J Aust 199(6 Suppl):S17–S20PubMedGoogle Scholar
  43. 43.
    Dworkin RH, Jensen MP, Gammaitoni AR, Olaleye DO, Galer BS (2007) Symptom profiles differ in patients with neuropathic versus non-neuropathic pain. J Pain 8(2):118–126.  https://doi.org/10.1016/j.jpain.2006.06.005 CrossRefPubMedGoogle Scholar
  44. 44.
    Solaro C, Messmer Uccelli M (2011) Management of pain in multiple sclerosis: a pharmacological approach. Nat Rev Neurol 7(9):519–527.  https://doi.org/10.1038/nrneurol.2011.120 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2017

Authors and Affiliations

  • Diana Ferraro
    • 1
  • Domenico Plantone
    • 2
    Email author
  • Franca Morselli
    • 1
  • Giulia Dallari
    • 3
  • Anna M. Simone
    • 1
  • Francesca Vitetta
    • 1
  • Patrizia Sola
    • 1
  • Guido Primiano
    • 4
  • Viviana Nociti
    • 4
    • 5
  • Matteo Pardini
    • 6
    • 7
  • Massimiliano Mirabella
    • 4
  • Catello Vollono
    • 4
  1. 1.Neurology Unit, Department of Biomedical Metabolic and NeurosciencesUniversity of Modena and Reggio EmiliaModenaItaly
  2. 2.S.O.C. Neurologia, Ospedale San BiagioDomodossolaItaly
  3. 3.Psychology Unit, Nuovo Ospedale Civile S. Agostino EstenseModenaItaly
  4. 4.Neurology InstituteUniversità Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino GemelliRomeItaly
  5. 5.Fondazione Don C Gnocchi OnlusMilanItaly
  6. 6.Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenoaGenovaItaly
  7. 7.IRCCS IST S. Martino HospitalGenoaItaly

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