#MSBlog: MS-asssociated pain; one of the biggest unmet treatment needs in MSers. Don’t suffer in silence!
Foley et al. Prevalence and natural history of pain in adults with multiple sclerosis: Systematic review and meta-analysis. Pain. 2012 Dec doi:pii: S0304-3959(12)00647-1.
Background: The prevalence, associations, and natural history of pain in MS are poorly understood.
Objective: The objective of this work was to study the prevalence of pain syndromes in MS both cross-sectionally, and longitudinally during the MS disease course.
Methods: We systematically identified prospective studies detailing pain prevalence in definite MS. We used pooled prevalence estimates, explored heterogeneity using meta-regression, and analysed prevalence during the disease course using both estimates at disease milestones and longitudinal studies.
Results: 28 articles (7101 subjects) describing overall pain, or pain syndromes, met inclusion criteria. Pooled overall pain prevalence (17 studies, 5319 subjects) was 63% (95% confidence interval [CI] 55-70%). Marked heterogeneity in this estimate was not significantly explained by selected study design variables (use of outpatient sample, timeframe prior to study over which pain was assessed) or sample demographic variables (mean EDSS, mean disease duration, proportion of female sex, and proportion with progressive MS). They quantified prevalence of headache (43%; 95% CI 33-52%), neuropathic extremity pain (26%; 95% CI 7-53%), back pain (20%; 95% CI 13-28%), painful spasms (15%; 95% CI 8.5-23%), Lhermitte’s sign (16%; 95% CI 10-25%), and trigeminal neuralgia (3.8%; 95% CI 2-6%) in included studies.
Conclusion: Prevalence of pain at MS disease milestones (prior to onset, at onset, and at relapse) and during longitudinal follow-up was poorly described. Pain is common in MS, as are specific pain syndromes. The clinical associations and natural history of pain in MS require clarification.
“This meta-analysis confirms what we already know that the majority of MSers experience pain. Some of the pain syndromes are not directly linked to MS, for example migraine. If you spend enough time looking after MSers you realise how much of your time is dedicated to managing pain. Pain impacts massively on quality of life. Pain reduces sleep, exacerbates or makes fatigue worse and is strongly associated with a low mood and even depression. There is a lot we can do about pain. So if you are suffering from pain please ask your neurologist for help.”