Characterizing chronic pain phenotypes in multiple sclerosis: a nationwide survey study

Area of Science:

• Neurology
• Pain Medicine
• Rheumatology

Background:

• Chronic pain significantly impacts individuals with multiple sclerosis (MS).
• Pain heterogeneity is a potential factor in suboptimal treatment responses.
• Understanding diverse pain phenotypes in MS is crucial for effective management.

Purpose of the Study:

• To characterize the distribution of pain phenotypes in people with MS.
• To compare pain phenotypes regarding pain intensity, chronic overlapping pain conditions (COPCs), and medication use/efficacy.
• To investigate the analgesic effects of different pain medication classes across phenotypes.

Main Methods:

• A national web-based survey was conducted with 842 adults experiencing chronic pain and MS.
• Pain was assessed using measures for neuropathic pain (painDETECT) and nociplastic pain (Fibromyalgia Survey Criteria).
• Data included COPCs, pain medication usage, and reported pain relief.

Main Results:

• Nociplastic pain was the most prevalent phenotype (41%), followed by mixed neuropathic/nociplastic (27%), nociplastic (23%), and neuropathic (9%).
• Nociplastic pain demonstrated significantly higher pain intensity and COPC frequency.
• Cannabis showed higher reported pain relief in nociplastic pain, while NSAIDs were rated highest for nociceptive pain.

Conclusions:

• Pain in MS is multifaceted, with nociplastic pain associated with greater severity and complexity.
• Current pain management yields modest relief, highlighting the need for multidimensional pain assessment.
• Identifying specific pain phenotypes in MS is essential for refining therapeutic strategies.