[Nociceptive and mixed pains in patients with multiple sclerosis]

Nociceptive and mixed pain syndromes (NMPS) whose pathogenesis is linked with the formation of plaques of demyelination in the CNS are commonly present in patients with multiple sclerosis (MS). NMPS of diverse locations, mechanisms and clinical features significantly worse patients' disability and impair their social adaptation. At the same time, clinicians do not pay enough attention to these syndromes in routine practice. Early diagnosis of NMPS may be important not only for early and appropriate NMPS' therapy and improvement of patients' quality of life, but, possibly, for the diagnosis of the onset or relapsing phase of MS, in cases when NMPS are the symptoms of MS and are the signs of active demyelinating process. This review addresses contemporary views of the main types of NMPS in MS (headaches, musculoskeletal pains, painful tonic spasms, pain with spasticity). Epidemiologic data, pathogenesis, clinical manifestations and diagnostic options of NMPS in patients with MS are described along with current views on MS and NMPS comorbidity theories. Existing approaches to treatment of NMPS based on randomized trials data are analyzed.