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An update on the pharmacological management of pain in patients with multiple sclerosis
Clara G Chisari1, Eleonora Sgarlata2,3, Sebastiano Arena1
1Department "GF Ingrassia", Section of Neurosciences, University of Catania , Catania, Italy.
Introduction:
The prevalence of pain in Multiple Sclerosis (MS) is estimated to be between 29-86% depending on various stages of the disease. According to a recent mechanism-based classification, MS pain syndromes include ongoing extremity pain, trigeminal neuralgia, and Lhermitte's phenomenon, painful tonic spasms and spasticity pain, pain associated with optic neuritis, musculoskeletal pain, migraine, and treatment-induced pain.
Area Covered:
Pharmacological approaches for MS pain include anticonvulsants, antidepressants, botulinum toxin, cannabinoids, muscle relaxants, opioid analgesics, and intrathecally administered baclofen. It has been reported that pharmacological treatments have poor efficacy and alarming side effects. For these reasons, non-pharmacological interventions, either alone or in combination with pharmacological treatments are commonly used in clinical practice. Examples of these interventions include electrical or chemical neurostimulation therapy, exercise, and psychological approaches. This is discussed in more detail herein.
Expert Opinion:
The management of MS pain can be challenging due to the natural course of the disease and the lack of a definite cure. Recommendations based on rigorous scientific methods for MS pain treatment are unavailable. Thus, clinicians should consider available treatment regimens based on efficacy, safety, cost, and the clinical complexity of the patient. The use of therapeutic approaches combining pharmacological and non-pharmacological treatments may help to reduce the risk of overuse and mitigate the complaint of simultaneous and multiple therapies.
Insights
Managing pain in Multiple Sclerosis (MS) is complex. Combining pharmacological and non-pharmacological treatments offers a balanced approach for patients with MS pain.
Area of Science:
- Neurology
- Pain Management
- Multiple Sclerosis Research
Background:
- Pain affects 29-86% of Multiple Sclerosis (MS) patients, varying by disease stage.
- MS pain encompasses diverse syndromes like extremity pain, trigeminal neuralgia, Lhermitte's phenomenon, spasms, and treatment-induced pain.
Purpose of the Study:
- To review current pharmacological and non-pharmacological interventions for managing pain in Multiple Sclerosis.
- To discuss the challenges and considerations in developing evidence-based treatment recommendations for MS pain.
Main Methods:
- Overview of pharmacological treatments including anticonvulsants, antidepressants, botulinum toxin, cannabinoids, muscle relaxants, opioids, and intrathecal baclofen.
- Exploration of non-pharmacological interventions such as neurostimulation, exercise, and psychological approaches.
- Discussion of the limitations and side effects associated with pharmacological MS pain management.
Main Results:
- Pharmacological treatments for MS pain often exhibit limited efficacy and significant side effects.
- Non-pharmacological interventions are frequently employed alongside or as alternatives to medication.
- Combined therapeutic strategies may enhance treatment outcomes and patient adherence.
Conclusions:
- Effective management of Multiple Sclerosis pain is challenging due to disease progression and lack of a definitive cure.
- Evidence-based guidelines for MS pain treatment are scarce, necessitating individualized treatment plans.
- Integrating pharmacological and non-pharmacological therapies can optimize safety, efficacy, and cost-effectiveness, while reducing polypharmacy risks.