How common is nerve pain in early MS?

Summary

This study examined how common nerve pain was in early MS, in 377 people with MS who attended a clinic in Germany.

Participants completed a PainDETECT questionnaire, which is a survey that was specifically developed to detect nerve pain. 4% of participants had scores on this questionnaire that indicated they were experiencing nerve pain. A further 9.5% had scores in a range where nerve pain is a possibility but cannot be confirmed as the type of pain.

Participants who were experiencing nerve pain, also had significantly higher levels of depression, fatigue and disability. The researchers suggest that treatment of the pain should take these other factors into account, to help improve overall wellbeing.

Background

Pain is a common symptom in MS and may have several causes. Some studies have suggested that up to 80% of people with MS may experience pain at some stage, but as pain is difficult to define, estimates vary as to how common it is. Nerve (neuropathic) pain is caused by damage to the nerves in the brain and spinal cord. Examples of nerve pain include trigeminal neuralgia, the MS hug, Lhermitte's sign and altered sensations such as pins and needles, numbness, crawling or burning feelings.

This study examined how common nerve pain was in early MS.

How this study was carried out

377 people with MS who attended a clinic in Germany took part in the study. Participants' average age was 36 years old, they had an average EDSS score of 1.6 and had lived with MS for an average of 4.2 years.

During their first visit to the clinic they completed a PainDETECT questionnaire. This is a survey that was specifically developed to detect nerve pain and has been used in the past for studies into pain in several health conditions including MS. The questionnaire contains questions about how severe the pain is, where it is, how it feels and if it is made worse by contact such as touching. Each question has an associated score and a total score of 19 of above (out of a total of 38) indicates nerve pain.

Participants also completed several other questionnaires that examined other MS symptoms and emotional aspects.

• Depressive symptoms were assessed using the Beck Depression Inventory II (BDI)
• Fatigue was assessed using the Fatigue Scale for Motor and Cognitive Functions (FSMC) 
• Cognitive function was assessed using the Paced Auditory Serial Addition Test (PASAT).

What was found

The study found that 4% of participants had scores (19 and above) that indicated they were experiencing nerve pain. A further 9.5% had scores between 13 and 18 where nerve pain could be a possibility but cannot be confirmed as the type of pain.

Participants who were experiencing nerve pain, also had significantly higher levels of depression, fatigue and disability.

What does it mean?

In this study nerve pain was not common in early MS. This is in contrast to previous studies that have found it to be much more common, affecting up to a third of people with MS. The researchers suggest that the difference in their results might be due to the characteristics of their participants which might be significantly different to the participants in other studies, so their results might not apply to the wider MS population. The study also only looked at one type of pain and assessed it using a questionnaire, if other methods were also used to assess pain they might find different results.

The researchers conclude that as the participants their study experiencing nerve pain also had higher levels of depression and fatigue, treatment of the pain should take these other factors into account. This should help improve overall wellbeing.

Heitmann H, Biberacher V, Tiemann L, et al.
Prevalence of neuropathic pain in early multiple sclerosis.
Mult Scler. 2015 Oct 19. pii: 1352458515613643. [Epub ahead of print]
abstract

More about nerve pain

Nerve pain (neuropathic pain) is the direct result of damage caused by MS to the covering of nerves in the brain and spinal cord. This damage interferes with the normal transmission of messages to the brain. The brain may interpret these disrupted messages as pain or as unusual feelings like numbness, pins and needles, crawling or burning. Other examples of nerve pain include trigeminal neuralgia, the MS hug and Lhermitte's sign. There are a range of options to manage pain including drug treatments or other therapies as well as lifestyle changes.

You can read more about pain and how to manage it in the A to Z of MS.

In the MS Trust newsletter Open Door, Dr Steve Allen, Consultant in Chronic Pain Management in Oxford talks about nerve pain in MS, its treatment and answer some common questions. Read his article here.