Predictors of neuropathic dysesthetic pain occurrence and chronification in multiple sclerosis (2-year prospective study)
Keywords:
multiple sclerosis, neuropathic dysesthetic pain, occurrence, chronification, predictorsAbstract
Background. Patients with multiple sclerosis (MS) are a high-risk group for neuropathic pain.
Objective: to investigate predictors of neuropathic dysesthetic pain (NDP) occurrence and chronification in patients with MS during a 2-year observation period.
Methods. After the exclusion criteria application and signing of informed consent, we recruited in the study 241 patients among which 23 patients prematurely stopped participating in the study. During the 2-year observation period, new NDP was diagnosed on the PainDETECT questionnaire (>18). Patients with newly diagnosed NDP were examined at baseline, in 1, 3, and 6 months depending on pain duration. The socio-demographic, neuropsychological, cognitive, sleep quality, and clinical characteristics of patients were evaluated at the beginning of the study and updated at baseline examination in cases of newly diagnosed NDP.
Results. Over a 2-year observation period, NDP occurred in 34 patients (15.6%). Out of 34 cases of newly diagnosed NDP, in 20 cases (58.9%) pain became chronic (lasting longer than 3 months). In the Cox proportional hazards multifactorial model, progressive types of MS were an independent predictor of NDP occurrence (hazard ratio 2.60; 95% confidence interval, 1.30-5.18; p=0.01). In the multifactorial logistic regression analysis, subclinical depressive disorders (according to Hospital Anxiety and Depression Scale) were identified as an independent predictor of NDP chronification (odds ratio 7.14; 95% confidence interval, 1.12-45.59; p=0.04).
Conclusions. In MS predictors of NDP occurrence are progressive types of MS, whereas predictors of NDP chronification are subclinical depressive disorders.
References
Kawachi I. Neuropathological features of “non‐motor” symptoms in multiple sclerosis and neuromyelitis optica. Clin Exp Neuroimmunol. 2019 Aug;10(3):161-8. doi: 10.1111/cen3.12533.
Titova N, Chaudhuri KR. Non-motor Parkinson disease: new concepts and personalised management. Med J Aust. 2018 May 21;208(9):404-9. doi: 10.5694/mja17.00993.
Delva I, Lytvynenko N, Delva M. Factors associated with post-stroke fatigue within the first 3 month after stroke. Georgian Med News. 2017 Jun 1(267):38-42. PMID: 28726651.
Foley PL, Vesterinen HM, Laird BJ, et al. Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis. Pain. 2013 May 1;154(5):632-42. doi: 10.1016/j.pain.2012.12.002.
O’Connor AB, Schwid SR, Herrmann DN, Markman JD, Dworkin RH. Pain associated with multiple sclerosis: systematic review and proposed classification. Pain. 2008 Jun 30;137(1):96-111. doi: 10.1016/j.pain.2007.08.024.
Nurmikko TJ, Gupta S, Maclver K. Multiple sclerosis-related central pain disorders. Current pain and headache reports. 2010 Jun;14:189-95. doi: 10.1007/s11916-010-0108-8.
Truini A, Galeotti F, Cruccu G. Treating pain in multiple sclerosis. Expert opinion on pharmacotherapy. 2011 Oct 1;12(15):2355-68. doi: 10.1517/14656566.2011.607162.
Truini A, Barbanti P, Pozzilli C, Cruccu G. A mechanism-based classification of pain in multiple sclerosis. Journal of neurology. 2013 Feb;260:351-67. doi 10.1007/s00415-012-6579-2.
Heitmann H, Haller B, Tiemann L, et al. Longitudinal prevalence and determinants of pain in multiple sclerosis: results from the German National Multiple Sclerosis Cohort study. Pain. 2020 Apr 1;161(4):787-96. doi: 10.1097/j.pain.0000000000001767.
Kahraman T, Özdoğar AT, Ertekin Ö, Özakbaş S. Frequency, type, distribution of pain and related factors in persons with multiple sclerosis. Mult Scler Relat Disord. 2019 Feb;28:221-225. doi: 10.1016/j.msard.2019.01.002.
Karakas H, Kaya E, Abasiyanik Z, Ozdogar AT. Investigation of neuropathic pain distribution and related factors in people with multiple sclerosis. J Mult Scler Res. 2022; 2(2): 46-51. doi: 10.4274/jmsr.galenos.2022.2022-7-2.
Kasap Z, Uğurlu H. Pain in patients with multiple sclerosis. Turk J Phys Med Rehabil. 2022 Feb 16;69(1):31-39. doi: 10.5606/tftrd.2022.10524.
Solaro C, Cella M, Signori A, et al. Identifying neuropathic pain in patients with multiple sclerosis: a cross-sectional multicenter study using highly specific criteria. J Neurol. 2018 Apr;265:828-35. doi: 10.1007/s00415-018-8758-2.
Foley P, Kong Y, Dirvanskiene R, et al. Coupling cognitive and brainstem dysfunction in multiple sclerosis-related chronic neuropathic limb pain. Brain Commun. 2022;4(3):fcac124. doi: 10.1093/braincomms/fcac124.
Fiest KM, Fisk JD, Patten SB, et al. Comorbidity is associated with pain-related activity limitations in multiple sclerosis. Mult Scler Relat Disord. 2015 Sep 1;4(5):470-6. doi: 10.1016/j.msard.2015.07.014.
Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006 Oct;22(10):1911-20. doi: 10.1185/030079906X132488.
Hallström H, Norrbrink C. Screening tools for neuropathic pain: can they be of use in individuals with spinal cord injury? PAIN®. 2011 Apr 1;152(4):772-9. doi: 10.1016/j.pain.2010.11.019.
Solaro C, Uccelli MM. Pharmacological management of pain in patients with multiple sclerosis. Drugs. 2010 Jul;70:1245-54. doi: 10.2165/11537930-000000000-00000.
Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology. 2015 Feb 1;14(2):162-73. doi: 10.1016/S1474-4422(14)70251-0.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70. doi: 10.1111/j.1600-0447.1983.tb09716.x.
Starkstein SE, Migliorelli R, Manes F, et al. The prevalence and clinical correlates of apathy and irritability in Alzheimer's disease. Eur J Neurol. 1995 Dec;2(6):540-6. doi: 10.1111/j.1468-1331.1995.tb00171.x.
Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989 Oct 1;46(10):1121-3. doi: 10.1001/archneur.1989.00520460115022.
Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9. doi: 10.1111/j.1532-5415.2005.53221.x
Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May 1;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4.
Treede RD, Rief W, Barke A, et al. A classification of chronic pain for ICD-11. Pain. 2015 Jun;156(6):1003. doi: 10.1097/j.pain.0000000000000160.
Carvalho T, Gomes C, Rodrigues A, da Motta C. Neuropathic pain, cognitive fusion, and alexithymia in patients with multiple sclerosis: cross-sectional evidence for an explanatory model of anxiety symptoms. J Clin Psychol. 2023 May;79(5):1342-1356. doi: 10.1002/jclp.23483.
Grau-López L, Sierra S, Martínez-Cáceres E, Ramo-Tello C. Analysis of the pain in multiple sclerosis patients. Neurología (English Edition). 2011 Jan 1;26(4):208-13. doi: 10.1016/S2173-5808(11)70043-8.
Chitnis T, Vandercappellen J, King M, Brichetto G. Symptom interconnectivity in multiple sclerosis: a narrative review of potential underlying biological disease processes. Neurol Ther. 2022 Sep;11(3):1043-70. doi: 10.1007/s40120-022-00368-2.
Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W. Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain. 2011 Sep 1;12(9):964-73. doi: 10.1016/j.jpain.2011.03.003.
Surah A, Baranidharan G, Morley S. Chronic pain and depression. Contin Educ Anaesth Crit Care Pain. 2014 Apr 1;14(2):85-9. doi: 10.1093/bjaceaccp/mkt046.
Martinelli Boneschi F, Colombo B, Annovazzi P, et al. Lifetime and actual prevalence of pain and headache in multiple sclerosis. Mult Scler J. 2008 May;14(4):514-21. doi: 10.1177/1352458507085551.
Truini A, Galeotti F, La Cesa S, et al. Mechanisms of pain in multiple sclerosis: a combined clinical and neurophysiological study. Pain. 2012 Oct 1;153(10):2048-54. doi: 10.1016/j.pain.2012.05.024.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Mykhaylo Delva, Kateryna Skoryk, Iryna Delva
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
