多发性硬化症患者疼痛分析。

Analysis of the pain in multiple sclerosis patients.

机构信息

Departamento de Neurociencias, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.

出版信息

Neurologia. 2011 May;26(4):208-13. doi: 10.1016/j.nrl.2010.07.014. Epub 2010 Oct 2.

DOI:10.1016/j.nrl.2010.07.014

PMID:21163193

Abstract

INTRODUCTION

Despite pain being a disabling symptom in patients with multiple sclerosis (MS), its prevalence and characteristics are not well established. The aim of this study is to describe the characteristics and prevalence of pain in patients with MS, and to assess the associated clinical variables and radiological findings.

METHODS

We prospectively studied patients with MS. A structured questionnaire which evaluated depression symptoms, type of pain, location, intensity (defined according to a visual analogue scale (VAS) as severe (VAS 7-10), moderate (VAS 4-6) and mild (VAS 0-4), and pain therapy was recorded in patients who referred to pain at the time of interview. Protocol variables were demographic data, MS clinical forms (remitting-relapsing, progressive-secondary and progressive-primary), neurological dysfunction (defined according to EDSS scale), symptoms at onset, attack frequency, illness duration, disease modifying treatment, fatigue, spasticity, oligoclonal bands in CSF, visual evoked potentials, depression symptoms (Hamilton test) and presence of lesions in spinal cord MRI.

RESULTS

A total of 134 MS patients were included, and MRI was performed on 105 of them. Pain was reported by 74 (55%) patients and was most frequently neuropathic, located in limbs, severe and burning/spiky. Of these 28 (38%) received therapy for their pain, based predominantly in anti-inflammatory drugs. Patients with pain had a worse functional state (EDSS score, 4.5 [3-6] vs 1.5 [1-2], p<0.001), higher number of relapses (7.13±3.4 vs 3.75±2.9, p<0.001), progressive forms of MS (86.7% vs 13.3%, p<0.001), depression (91.9% vs 8.1%, p<0.001), spinal cord involvement at onset (79.2% vs 20.8%, p=0.009), spinal cord lesions by MRI (84.3% vs 15.7%, p<0.001) and longer duration of disease (14.6±7.8 vs 8.43±5.9 months, p<0.001). In a logistic regression model, the presence of lesions in spinal cord MRI (OR 3.5 [1.5-24.5]) and higher EDSS score (OR 1.7 [1.1-2.7]) were independently associated with pain.

CONCLUSIONS

Pain is a frequent disabling symptom in MS and is associated with disability and spinal cord lesions.

摘要

简介

尽管疼痛是多发性硬化症（MS）患者的一种致残症状，但疼痛的患病率和特征尚未得到充分确立。本研究旨在描述 MS 患者疼痛的特征和患病率，并评估相关的临床变量和影像学发现。

方法

我们前瞻性研究了 MS 患者。在访谈时提到疼痛的患者记录了一份结构化问卷，该问卷评估了抑郁症状、疼痛类型、位置、强度（根据视觉模拟量表（VAS）定义为严重（VAS7-10）、中度（VAS4-6）和轻度（VAS0-4））和疼痛治疗。方案变量包括人口统计学数据、MS 临床形式（缓解-复发、进行性-继发性和进行性-原发性）、神经功能障碍（根据 EDSS 量表定义）、发病时症状、发作频率、疾病持续时间、疾病修正治疗、疲劳、痉挛、CSF 中的寡克隆带、视觉诱发电位、抑郁症状（汉密尔顿测试）和脊髓 MRI 中的病变。

结果

共纳入 134 例 MS 患者，其中 105 例进行了 MRI 检查。74 例（55%）患者报告有疼痛，疼痛主要为神经性疼痛，位于四肢，疼痛严重且呈烧灼感/刺痛感。其中 28 例（38%）患者接受了疼痛治疗，主要基于抗炎药物。有疼痛的患者功能状态较差（EDSS 评分 4.5[3-6]vs1.5[1-2]，p<0.001），复发次数较多（7.13±3.4vs3.75±2.9，p<0.001），MS 呈进行性形式（86.7%vs13.3%，p<0.001），抑郁（91.9%vs8.1%，p<0.001），发病时脊髓受累（79.2%vs20.8%，p=0.009），脊髓 MRI 病变（84.3%vs15.7%，p<0.001）和疾病持续时间较长（14.6±7.8vs8.43±5.9 个月，p<0.001）。在逻辑回归模型中，脊髓 MRI 病变的存在（OR3.5[1.5-24.5]）和较高的 EDSS 评分（OR1.7[1.1-2.7]）与疼痛独立相关。