Objectives:

Even though multiple sclerosis (MS) is not considered to be a painful disease, painful symptoms are frequently encountered in patients with MS. The objective of this study was to investigate various types of pain and clinical features associated with these pains in patients with MS.

Materials and Methods:

Seventy consecutive patients followed up with relapsing remitting MS were included in the study. Besides demographic and clinical characteristics of patients, expanded disability status scale (EDSS) scores, cranial and spinal demyelinating lesions were recorded. Patients were investigated for migraine, tension-type headache (TTH), treatment-related headache, Lhermitte sign, neuropathic limb pain, painful tonic spasms, low back pain, and mechanical limb pain, and also evaluated for associated fatigue, depression and anxiety symptoms.

Results:

Of the 70 patients (54 females, 16 males, mean age 36.2±7.9) 64 had one or more painful disorders (91.4%). Low back pain was the most common painful symptom (48.6%) followed by migraine (38.6%) and treatment-related headache (31.1%). Fatigue, depression and anxiety were found to be more frequently in patients with migraine than in those without migraine (p=0.027, p=0.01 and p=0.016, respectively). The duration of MS was longer in patients with neuropathic pain (p=0.018). Patients with neuropathic limb pain, Lhermitte sign, and low back pain had higher EDSS scores (p<0.001, p=0.007 and p=0.035, respectively). It was found that depression was more frequent in patients with neuropathic limb pain (p=0.005) and anxiety was more frequent in patients with low back pain (p=0.03). Demyelinating lesions were found to be more frequent in internal capsule in patients with TTH (p=0.05); in internal capsule and cervical spinal cord in patients with neuropathic limb pain (p=0.033 and p=0.019, respectively); and in pons and cervical spinal cord in patients with Lhermitte sign (p=0.031 and p<0.001, respectively).

Conclusion:

The results of our study have shown that pain is a very common symptom in patients with MS and have pointed out that patients with MS may have a wide variety of pain in which neurogenic or nociceptive mechanisms play a role. Identification of pain will be helpful to initiate appropriate treatment and to improve the quality of life in patients with MS.

Keywords: Multiple Sclerosis, Pain, Headache, Migraine, Neuropathic Pain