• Curr Pain Headache Rep · Jun 2010

    Review

    Multiple sclerosis-related central pain disorders.

    • Turo J Nurmikko, Sameer Gupta, and Kate Maclver.
    • Neuroscience Research Unit, Clinical Sciences Centre, Lower Lane, Liverpool, L9 7AL, UK. tjn@liverpool.ac.uk
    • Curr Pain Headache Rep. 2010 Jun 1;14(3):189-95.

    AbstractCentral 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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