Chronic intractable pain: an atypical presentation of multiple sclerosis

Both acute paroxysmal pains and a variety of chronic pain syndromes have been described in multiple sclerosis. These usually occur in the setting of well-established disease. Although paroxysmal pain has been recognized as a rare first symptom in this disorder, presentation with severe, continuous dysesthesias of long duration has not been previously appreciated. We report the cases of three patients in whom refractory continuous pain signalled the onset of demyelinating disease. These observations further define the clinical spectrum of multiple sclerosis and have implications for the evaluation of patients with chronic neuropathic pains of unknown etiology.