Definition | Diagnostic criteria | Epidemiology | Risk Factors | Pathophysiology | Presentation | Examination | Differential diagnosis | Investigations | Management | Prognosis | Golden Pearls | Quiz | References/Articles/Resources |
Definitions/Diagnostic criteria
Epidemiology (MS Guide Sheet)
Pain is a common symptom in MS
Incidence of pain within one-month is between 53-79%
Point prevalence is about 50% (not including headache)
Chronic pain in 65%
Risk factors (for pain in MS)
Higher pain levels in females
Higher age
Number of years since disease onset
Moderate-Severe mobility and disability restriction
Multiple sites of involvement
Pathophysiology
Central nerve pain is thought to be the predominant pain mechanism in MS
It is propagated by two mechanisms:
- Generation of ectopic impulses at demyelinated lesions in response to neural damage
- Interruption of inhibitory impulses from the brain
Nociceptive pain (particularly in lower back, neck, and head) can occur from irregular, asymmetric movement patterns and postures and changes in muscle strength, tone (spasticity), or length (contracture)
It can also be from spasticity and muscle spasm causing aching, cramping, pulling or stiffness. These are often worse at night or early in the morning.
Pain from fractures can be a feature and osteoporosis needs to be considered
Headache can be caused by cervical demyelinating plaques, posture, cervicogenic changes, or even from medications
Pain can be further broken down into these subgroups:
Continuous central neuropathic pain (e.g. dysaesthetic extremity pain)
Intermittent central neuropathic pain (e.g. Trigeminal neuralgia)
Musculoskeletal pain (e.g. Painful tonic spasms, muscle spasms)
Mixed neuropathic and non-neuropathic pain (E.g. Headache)
Presentation (for those with pain in MS)
Often significantly effects activities of daily living
40% have difficulty working, 44% have difficulty sleeping, and 34% have troubled relationships
Increased risk for comorbid anxiety, depression, and lower mental health scores
Lhermitte's sign and painful tonic spasms are thought to be due to the demyelination process
Pressure area pains can occur
Painful tonic spasms
Examination
Differential diagnosis
Investigations
Treatment
Prognosis
Golden pearls
Quiz
References / Articles / Resources
MS Practice - Health Practioner guide sheet https://www.msaustralia.org.au/file/277/download?token=X4VwBok3
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