Background & Aims
Chronic pain is a common symptom in patients with multiple sclerosis (pwMS) (1). Pain is associated with increased disability, depression and fatigue; it is perceived as one of the most distressing symptoms (2). Pain occurs early in the course of MS and might play a role in the choice of treatment (2). Nevertheless, there is no standardized work-up of chronic pain in pwMS. Chronic pain may be classified as nociceptive, neuropathic or nociplastic (3). Nociplastic pain often includes chronic widespread pain (CWP). Despite its estimated impact on around 17% of pwMS, nociplastic chronic widespread pain receives little attention in many studies and is rarely recorded in clinical practice (4). This study elaborates on the prevalence and characteristics of CWP in pwMS.
Methods
To date, 262 patients (age: 42.2 ± 11.9 years; 179 women and 83 men) with multiple sclerosis (223 with relapsing-remitting, 22 with primary progressive and 17 with secondary progressive form; Expanded Disability Status Scale EDSS 2.2 ± 2.1) from the Department of Neurology at the UMC Mainz have been recruited and is still ongoing. Patients were clinically assessed by a neurologist (EDSS, etc.). The presence of CWP was recorded using the revised ACR 2010 criteria for chronic widespread pain. Patients were asked if spasms induced the pain and they completed the Brief Pain Inventory (BPI), the Neuropathic Pain Symptom Inventory (NPSI) and the Resilience Scale (RS-13) questionnaire. Using md.brain and AIRAscore, a proprietary software based on voxel-based morphometry, cerebral MRI scans were examined with regard to lesion burden and location, as well as lesion and brain volumes.
Results
56% of pwMS reported chronic body pain. 34% of these were classified as nociplastic CWP, 19% as spasticity-associated nociceptive pain and 24% as central neuropathic pain. 23% could not be assigned to any category which included e.g. pain due to strain or back pain. Overall, the prevalence of CWP in this cohort according to ACR criteria was 17%. pwMS with CWP reported a significantly higher mean pain intensity and a higher impairment of different functions like activity, walking, working or sleep (paired t-test, p < 0 05) than pwMS without CWP. Patients with a progressive MS course have more frequent CWP (Pearson chi-square p < 0.003). Age, last MS relapse, EDSS and RS-13 did not differ between the groups. Pain quality is most frequently described as "dull", "pulling" and "stabbing" in CWP. Further analyses (e.g. magnetic resonance imaging data, more specific clinical distinctions) are still pending and will be completed during the next months.
Conclusions
Most body pain in pwMS can be classified as “nociceptive” “nociplastic” and “neuropathic” based on the question about spasticity associated pain, the ACR criteria for CWP and questionnaires for neuropathic pain. CWP is an important common type of pain in pwMS. After evaluation of all data, further conclusions regarding the pathophysiology of pain in MS will be possible.
References
1.O’Connor AB, Schwid SR, Herrmann DN, Markman JD, Dworkin RH. Pain associated with multiple sclerosis: systematic review and proposed classification. Pain. 2008;137(1):96-111.
2.Heitmann H, Haller B, Tiemann L, Muhlau M, Berthele A, Tolle TR, et al. Longitudinal prevalence and determinants of pain in multiple sclerosis: results from the German National Multiple Sclerosis Cohort study. Pain. 2020;161(4):787-96.
3.Nicholas M, Vlaeyen JWS, Rief W, Barke A, Aziz Q, Benoliel R, et al. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019;160(1):28-37.
4.Clemenzi A, Pompa A, Casillo P, Pace L, Troisi E, Catani S, et al. Chronic pain in multiple sclerosis: is there also fibromyalgia? An observational study. Med Sci Monit. 2014;20:758-66.
Presenting Author
Livia Steenken
Poster Authors
Livia Steenken
Department of Neurology, University of the Johannes-Gutenberg University Mainz, Germany
Lead Author
Panoraia Baka
Department of Neurology, University of the Johannes-Gutenberg University Mainz, Germany
Lead Author
Violeta Dimova
Department of Neurology, University of the Johannes-Gutenberg University Mainz, Germany
Lead Author
Maria Protopapa
Lead Author
Sebastian Steinmetz
Department of Neuroradiology, University of the Johannes-Gutenberg University Mainz, Germany
Lead Author
Stefan Bittner
Department of Neurology, University of the Johannes-Gutenberg University Mainz, Germany
Lead Author
Frank Birklein
Department of Neurology, University Medical Center, Mainz, German
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Nociplastic and chronic widespread pain