Summary
Both acute paroxysmal pains and a variety of chronic pain syndromes have been described in multiple sclerosis. These usually occur in the setting of well-established disease. Although paroxysmal pain has been recognized as a rare first symptom in this disorder, presentation with severe, continuous dysesthesias of long duration has not been previously appreciated. We report the cases of three patients in whom refractory continuous pain signalled the onset of demyelinating disease. These observations further define the clinical spectrum of multiple sclerosis and have implications for the evaluation of patients with chronic neuropathic pains of unknown etiology.
Similar content being viewed by others
References
Albert ML (1969) Treatment of pain in multiple sclerosis: preliminary report. N Engl J Med 28:1395
Carter S, Sciarra D, Marritt HH (1950) The course of multiple sclerosis as determined by autopsy proven cases. Proc Assoc Res Nerv Ment Dis 28:471–511
Charcot JM (1872) Lecons sur les maladies due systeme nerveux faites a la Alspetriere. Delahaye, Paris, pp 239–240
Clifford DB, Trotter JL (1984) Pain in multiple scerlosis. Arch Neurol 41:1270–1272
Espir MLE, Millac P (1970) Treatment of paroxysmal disorders in multiple sclerosis with carbamazepine (Tegretol). J Neurol Neurosurg Psychiatry 33:528–531
Jensen TS, Rasmussen P, Reske-Nelsen E (1982) Association of trigeminal neuralgia with multiple sclerosis: clinical and pathological features. Acta Neurol Scand 65:182–189
Kassirer MR, Osterberg DH (1987) Pain in chronic multiple sclerosis. J Pain Symp Manag 2:95–97
Kelly R (1985) Clinical aspects of multiple sclerosis. In: Vinken PJ, Bruyn GW, Klawans HL (eds), Handbook of clinical neurology, vol 47. Elsevier, Amsterdam, pp 49–78
Moulin DE, Foley KM, Ebers GC (1985) Acute and chronic pain syndromes in multiple sclerosis. Fifth General Meeting of the American Pain Society, Dallas, Texas, 17–25 October
Osterman PO, Westerberg CE (1975) Paroxysmal attacks in multiple sclerosis. Brain 98:189–202
Portenoy RK, Foley KM (1986) Chronic use of opioid analgesic in non-malignant pain: report of 38 cases. Pain 25:171–186
Poser CM, Paty DW, Scheinberg L, McDonald I, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231
Rushton JG, Olafson RA (1965) Trigeminal neuralgia associated with multiple sclerosis: report of 35 cases. Arch Neurol 13:383–386
Schumacher GA, Beebe GW, Kibler RF, Kurland LT, Kurtzke JF, McDowell F, Nagler B, Sibley WA, Tourtellotte WW, Willmon TL (1965) Problems of experimental trials of therapy in multiple sclerosis. Ann NY Acad Sci 122:552–568
Shibasaki H, Kuroiwa Y (1974) Painful tonic seizure in multiple sclerosis. Arch Neurol 30:47–51
Tasker RR (1984) Deafferentation. In: Wall PD, Melzack R (eds) Textbook of pain. Churchill Livingstone, Edinburgh, pp 119–132
Tibbling G, Link H (1977) Principles of albumin and IgG analyses in neurological disorders. I. establishment of reference values. J Clin Lab Invest 37:385–390
Tourtellotte WW, Baumhefner RW (1983) Comprehensive management of multiple sclerosis. In: Hallpike JF, Adams CWM, Tourtellotte WW (eds) Multiple sclerosis. Williams & Wilkins, Baltimore, pp 513–578
Twomey JA, Espir MLE (1980) Paroxysmal symptoms as the first manifestations os multiple sclerosis. J Neurol Neurosurg Psychiatry 43:296–304
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Portenoy, R.K., Yang, K. & Thorton, D. Chronic intractable pain: An atypical presentation of multiple sclerosis. J Neurol 235, 226–228 (1988). https://doi.org/10.1007/BF00314351
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00314351