Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system, specifically the brain and spinal cord. This disease affects women twice the amount as men. Onset commonly occurs between ages 20 and 50 years.
There are many negative consequences of multiple sclerosis. It is known to cause chronic neuroinflammation and demyelination. The cause of this disease remains unknown.
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Pain or Motor Symptoms
Motor impairment is a primary problem in MS. 81.6% of MS cases experience motor impairment. Neuropathic pain experienced widely varies in prevalence and level of intensity. 14% of MS cases experience neuropathic pain.
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Treating Neuropathic Pain and MS
Ongoing extremity pain is experienced by 12-28% of neuropathic MS cases. Possible mechanisms include thalamic or cortical deafferentation pain by multiple lesions along the spino-thalamo-cortical pathways. Treatments include antidepressants and cannabinoids.
Lhermitte’s phenomenon is experienced by around 15% of neuropathic MS cases. Causes can include high-frequency discharges ectopically generated by demyelination of the dorsal column primary afferents. A theoretical treatment includes sodium-channel blockers.
Trigeminal neuralgia is experienced by 2-5% of neuropathic MS cases. Possible causes or symptoms include high-frequency discharges ectopically generated by intra-axial inflammatory demyelination or extra-axial mechanical demyelination of the trigeminal primary afferents. Treatments include sodium-channel blockers and microvascular decompression.
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Mixed Pains and MS
Spasticity pain is experienced by nearly 50% of mixed pain MS cases. Possible mechanisms can occur when disinhibition by a corticospinal tract lesion enhances the tonic stretch reflex, which in turn gives rise to excessive muscular work and mechanical muscle pain. Treatments include anti-spastic agents and cannabinoids.
Painful tonic spasms are experienced by 6-11% of mixed pain MS cases. This can be caused when high-frequency discharges ectopically generated by demyelination in the corticospinal pathways induce spasmodic muscle contractions, which in turn induce ischemic muscle pain.
Nociceptive Pains and MS
Migraines are a type of nociceptive pain that makes up 34% of these MS cases. These can occur when two diseases share predisposing factors or from midbrain lesions. Standard treatments for migraines should be implemented.
Other tension-type headaches make up 21% of nociceptive pain MS cases. There is no evidence against coexisting conditions. Standard treatment for tension headaches should be implemented.
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Musculoskeletal pains induced by postural anomalies and general back pain make up over 16% of nociceptive MS cases. Standard pharmacological treatment and physiotherapy should be implemented.
Nerve trunk pain associated with optic neuritis makes up 8% nociceptive pain MS cases. Possible mechanisms include endoneural inflammation that activates intraneural nociceptors of the nervi nervorum. Treatment includes corticosteroids.
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