Chapter 31 - Multiple Sclerosis Pain

Summary

Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system, causing inflammation with oligodendrocyte death and myelin sheath destruction. Classical symptoms of MS are fatigue, paresthesia, motor deficits, cognitive dysfunction, visual disturbances (due to optic neuritis), spasticity, depression, gait disturbance, and pain. To make a formal diagnosis of MS, the 2017 McDonald criteria is used. Pain in MS can present itself as headache, extremity pain, back pain, neuropathic pain, or more specifically, trigeminal neuralgia. Pain in MS can be severe and chronic enough to cause disability and decreased quality of life. The prevalence of neuropathic pain in MS can be as high as 86% and it can manifest itself as back pain, headache, trigeminal neuralgia, or extremity pain. When present, it is associated with MS, which tends to be more severe, with a higher degree of disability. Early treatment of these pains leads to better outcomes of MS itself. Conventional methods to treat pain in these patients produce only a 50% reduction in symptomatology. Some unconventional treatment modalities that have benefited patients are antidepressants, anticonvulsants, cannabinoids, low-dose naltrexone, and spinal stimulation.