Chapter 13 - Central pain symptoms in multiple sclerosis

Summary

Multiple sclerosis (MS) can lead to numerous types of pain through the processes of inflammation and degeneration. The common types of pain seen in MS include dysesthetic/extremity pain, trigeminal neuralgia (TN), spasticity, L'hermitte's phenomenon, painful tonic spasms (PTS), musculoskeletal, headache, optic neuritis, and treatment related pain. This chapter focuses on the first five, with a particular focus on dysesthetic pain. The acute onset of dysesthetic pain in the setting of a relapse in a relapsing-remitting MS (RRMS) patient is clearly due to an inflammatory lesion. The inciting pathology of TN in MS is a lesion which affects the primary afferents of the trigeminal nerve after they enter the pons, distal to the trigeminal nuclear complex, in the root entry zone (REZ). Considering that people with MS are already predisposed to poor sleep, depression, and a poor quality of life, the presence of pain is particularly debilitating.