PREVALENCE AND CLINICAL CHARACTERISTICS OF NEUROPATHIC PAIN IN MULTIPLE SCLEROSIS

Delva M. Yu., Skoryk K.S.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Neuropathic pain (NP) in multiple sclerosis (MS) is a common phenomenon that limits patient social activity, significantly affects the level of disability and life quality. Objective. To study the prevalence and clinical characteristics of NP in patients with MS. Material and methods. During 2 years, we recruited 321 patients with MS – 110 males (34,3 %) and 211 females (65,7 %), aged 21 to 55 years. In 247 cases (76,9 %) was recurrent-remitting, in 2 (0,6 %) – primary progressive, in 72 (22,5 %) – secondary progressive MS. As control group, it had been recruited 83 practically healthy persons (PHP) – 39 males (47 %) and 44 females (53 %) aged 19 to 58 years. Patients were asked about any pain during the last month, in the case of positive answer we detailed pain nature. The analysis did not include the pain as visceral pathology manifestation. NP was determined due to pain scales indicators: DN 4 ≥4 points, LANSS > 12 points, PainDETECT > 18 points. In other cases, pain was considered as nociceptive or mixed. According to PainDETECT scale, we examined pain intensity during the last 4 weeks, pain location and pain clinical course. Quantitative values were presented as median (Me) and interquartile range (Q1-Q3) (25 %-75 %). Significance of differences between quantitative values was performed using the paired Mann-Whitney U-test. Qualitative values were presented as a percentage with 95 % confidence interval. Comparisons of frequencies in individual groups of patients were performed using Fisher’s exact bilateral test. Quantitative analysis of the frequency of event occurrence in groups was performed using «odds ratio» (OR) with 95 %confidence interval. Differences at p <0,05 were considered as significant. Results and discussion. During the last month 75,7 % (70,7 %-80,1 %) MS patients had pain, which was significantly higher than pain prevalence in PHP group – 42,2 % (32,1 %-51,9 %). In MS patients, compared with PHP, likelihood was higher for general pain (OR 4,27, 2,58–7,08; p<0,0001), for NP (OR 4,43, 1,73–11,36; p=0,002), for dysesthesia (OR 3,30, 1,28–8,52; p=0,01), for non-NP (OR 3,81, 2,08–6,95; p<0,001). In MS patients, central NP was presented as dysesthesia – in 11,8 % (8,8 %-15,8 %), Lhermitte’s phenomenon – in 4,1 % (2,4 %-6,8 %) and trigeminal neuralgia – in 0,6 % (0,2 %-2,2 %) cases. Clinical patterns of NP were presented as «constant pain of the same intensity» – 18,4 % (9,2 %-33,4 %), «constant pain with periods of increased intensity» – 42,1 % (27,9 %-57,8 %), «periodic pain with painless periods» – 39,5 % (25,6 %-55,3 %) cases. Patients described central dysaesthesias as burning – 81,6 % (66,6 %-90,8 %), cold – 76,3 % (60,1 %-87,0 %), tingling – 68,4 % (52,5 %-80,9 %), painful numbness – 65,8 % (49,9 %-78,8 %), squeezing – 60,5 % (44,7 %-74,4 %), compression – 47,4 % (32,5 %-62,7 %), shooting – 39,5 % (25,6 %-55,3 %). Central dysesthesias in the form of one descriptor were in 7,9 % (2,7 %-20,8 %), in the form of 2 – in 26,3 % (15,0 %-42,0 %), in the form of 3 – in 42,1 % (27,9 %-57,8 %), in the form of 4 – in 18,4 % (9,2 %-33,4 %), in the form of 5 – in 5,3 % (1,5 %-17,3 %) of patients. Pain due to Lhermitte’s phenomenon was located predominantly in the neck and back areas, whereas pain due to dysesthesia – in the lower extremities. 23,7 % (13,0 %-39,2 %) patients had central dysesthesia in 1 body area, 31,6 % (19,1 %-47,5 %) – simultaneously in 2 areas, 26,3 % (15,0 %-42,0 %) – in 3 areas, 13,2 % (5,8 %-27,3 %) – in 4 areas, 5,2 % (1,5 %-17,3 %) – in 5 areas; Lhermitte’s phenomenon in 1 body area had 7,7 % (1,4 %-33,3 %), in 2 areas – 46,2 % (23,2 %-70,9 %), in 3 areas – 30,8 % (12,7 %-57,6 %) and in 5 areas – 15,3 % (4,3 %-42,2 %) patients. Intensity of dysesthesia pain and pain due to Lhermitte’s phenomenon were much less similar – 6,0 (5,0–7,0) and 6,0 (6,0–7,0) points on a visual analog scale. 60,5 % (44,7 %-74,4 %) patients with central dysaesthesia had analgesic therapy: nonsteroidal analgesics – 13,2 % (5,8%-27,3%), gabapentinoids – 13,2% (5,8%-27,3%), tricyclic antidepressants – 5,3% (1,5%-17,3%), selective serotonin reuptake inhibitors – 7,9 % (2,7 %-20,8 %), simultaneous usage of several drug groups – 21,1 % (11,1 %-36,3 %). 84,6 % (57,8 %-95,7 %) patients with Lhermitte’s phenomenon took analgesic therapy: gabapentinoids – 38,5 % (17,7 %-64,5 %),tricyclic antidepressants – 15,4 % (4,3 %-42,2 %), non-steroidal analgesics – 7,7 % (1,4 %-33,3 %), carbamazepine – 7,7 % (1,4 %-33,3 %), simultaneous usage of several drug groups – 15,4 % (4,3 %-42,2 %). Conclusions. 1. MS patients have increased risk of NP as well as other pain types (nociceptive and mixed pain). 2. Central NP in MS patients presented in form of central dysaesthesia, Lhermitte’s phenomenon and trigeminal neuralgia. 3. In MS patients central NP localized predominantly more than one body areas: Lhermitte’s phenomenon – in the neck and low back area, dysaesthesia – in the lower extremities.

multiple sclerosis, neuropathic pain, Lhermitte’s phenomenon, dysesthesia, trigeminal neuralgia.

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«Bulletin of problems biology and medicine» Issue 2 Part 1 (164), 2022 year, 145-157 pages, index UDK 616.832–004.2–071

10.29254/2077-4214-2022-2-1-164-145-157