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Multiple Sclerosis-Related Central Pain Disorders

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Abstract

Central neuropathic pain is common in multiple sclerosis (MS), and its prevalence increases with physical disability. Sufficient evidence links dysesthetic pain, trigeminal neuralgia, Lhermitte’s sign, and painful tonics spasms to plaque formation in the spinal cord and brain, whereas the association with headache and back pain remains unclear. Management varies according to the pain in question. For dysesthetic pain, drugs in use for neuropathic pain in general are recommended as first-line treatment, and emerging evidence suggests some benefit from cannabinoids and levetiracetam. Because of unique characteristics of MS-related trigeminal neuralgia, ganglion and root level neuroablative procedures are worth considering before microvascular decompression. Overall, the lack of controlled clinical trials, together with our limited understanding of the pathophysiological mechanisms involved, form a hindrance to a systematic and rational management of MS-related pain.

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Disclosure

Dr. Turo J. Nurmikko has acted as a consultant to Grunenthal and Astellas, and received an honorarium for speaking symposia supported by Pfizer and Sanofi Pasteur MSD. No other potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Neuroscience Research Unit, Clinical Sciences Centre, Lower Lane, Liverpool, L9 7AL, UK

    Turo J. Nurmikko

  2. The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK

    Sameer Gupta

  3. Neuroscience Research Unit, School of Clinical Sciences, University of Liverpool, Liverpool, UK

    Kate Maclver

Authors
  1. Turo J. Nurmikko
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  2. Sameer Gupta
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  3. Kate Maclver
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Correspondence to Turo J. Nurmikko.

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Nurmikko, T.J., Gupta, S. & Maclver, K. Multiple Sclerosis-Related Central Pain Disorders. Curr Pain Headache Rep 14, 189–195 (2010). https://doi.org/10.1007/s11916-010-0108-8

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