Chronic Pain in Multiple Sclerosis: Mechanisms, Clinical Characteristics and Treatment Strategies

Chronic pain is an underestimated and undertreated yet highly prevalent symptom in people with multiple sclerosis (pwMS), significantly impairing quality of life and functional outcomes. Its prevalence ranges from 23% to 90% across studies, reflecting methodological differences and discrepancies in the definition and recognition of chronic pain. In this article, we aim to provide an updated review of the pathophysiological mechanisms of chronic pain in MS, including the effect and interaction between neuropathic, nociceptive and nociplastic mechanisms, and propose a mechanism-based classification. Furthermore, we explore different therapeutic approaches, including both pharmacological and non-pharmacological interventions, tailored to each patient according to the mechanism involved. A deeper understanding of the distinct chronic pain mechanisms and phenotypes can provide more effective and personalized treatment strategies and lead to improved patient outcomes and quality of life.