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Curr Pain Headache Rep. 2019 Jul 25;23(8):59. doi: 10.1007/s11916-019-0800-2.

Advances in the Understanding and Management of Chronic Pain in Multiple Sclerosis: a Comprehensive Review.

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Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA.
A T Still University, Kirksville College Of Osteopathic Medicine, Kirksville, MO, USA.
Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.
Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.



Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system that can lead to severe physical, cognitive, and neurological deficits that often manifest in young adults. Central neuropathic pain is a common presenting symptom, often prompting patients to seek treatment with opioids, NSAIDS, antiepileptics, and antidepressants despite minimal effectiveness and alarming side-effect profiles. Additionally, spasticity occurs in more than 80% of MS patients and is an important consideration for further study in treatment.


Related to inconsistencies in pain presentation and clinical reporting, current studies continue to investigate clinical patient presentation to define chronic pain characteristics to optimize treatment plans. Although often neuropathic in origin, the complex nature of such pain necessitates a multimodal approach for adequate treatment. While psychiatric comorbidities typically remain unchanged in their severity over time, physical conditions may lead to worsening chronic pain long-term, often due to decreased quality of life. The prevalence of neuropathic pain is ~‚ÄČ86% in patients with multiple sclerosis and most commonly presents as extremity pain, trigeminal neuralgia, back pain, or headaches. As MS symptoms are frequently unremitting and poorly responsive to conventional medical management, recent attention has been given to novel interventions for management of pain. Among these, medicinal cannabis therapy, targeted physical therapy, and neuromodulation offer promising results. In this review, we provide a comprehensive update of the current perspective of MS pathophysiology, symptomatology, and treatment.


Chronic pain; Cns; Ms; Multiple sclerosis; Neuropathic pain

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