Chronic pain syndromes in patients with demyelinating diseases of the central nervous system

Early chronic pain syndromes (CPS) of various mechanisms, locations and clinical features are common in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). These CPS are typically linked to demyelinating diseases resulting from focal central nervous system (CNS) lesions and/or neurological symptoms. Pain sometimes demonstrates active demyelinating process, and this may be very important for early diagnosis and appropriate therapy for MS and NMOSD. CPSs significantly reduce the quality of life, social adaptation of patients and worsen disability. The review provides data on MS and NMOSD pathogenesis and current understanding of the most typical CPS in MS and NMOSD (central neuropathic pain, trigeminal neuralgia, Lhermitte’s sign, headaches, musculoskeletal pains, painful tonic spasms, pain associated with spasticity). Comparative epidemiological data on the prevalence of chronic pain in MS and NMOSD are presented. The authors analyze pathophysiologic mechanisms of CPS, role of structural CNS damage and clinical manifestations of CPS in MS and NMOSD. The review discusses the role of disease modifying treatment for CPS and available approaches to symptomatic drug and non-drug therapy of CPS, as well as neurosurgical methods.