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Multiple Sclerosis. Need to know

Updated: May 17, 2021

 

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:

  1. Continuous central neuropathic pain (e.g. dysaesthetic extremity pain)

  2. Intermittent central neuropathic pain (e.g. Trigeminal neuralgia)

  3. Musculoskeletal pain (e.g. Painful tonic spasms, muscle spasms)

  4. 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

  1. MS Practice - Health Practioner guide sheet https://www.msaustralia.org.au/file/277/download?token=X4VwBok3


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