Department of Neurology, PA Micone Hospital, ASL3 Genovese, Via Oliva 22, Genoa, 16153, Italy.
Nat Rev Neurol. 2011 Aug 16;7(9):519-27. doi: 10.1038/nrneurol.2011.120.
About half of patients with multiple sclerosis (MS) report pain; treatment for pain alone accounts for nearly 30% of the total use of medications for the management of all MS-related symptoms. Patients with MS can experience more than one type of pain simultaneously and at any point during the disease course, even in newly or recently diagnosed cases. Pain in MS can be associated with other symptoms, including spasticity, fatigue and mood disorder. Pain sufferers experience disruption in daily life activities, work, mood, recreation and general enjoyment of life, and report low satisfaction with pain management. Many clinical features of pain are often unrecognized by clinicians and are difficult for patients to describe. The majority of clinical evidence regarding treatment stems from small pilot and open-label studies; therefore, treatment of pain associated with MS is often based on anecdotal reports and clinicians' experience. The open-label design of the majority of studies, the unavailability of large samples and the difficulty of performing placebo-controlled studies because of ethical considerations result in insufficient evidence to support or refute the effectiveness of pain medications. This Review presents available data regarding pharmacological approaches for addressing pain in MS and highlights the shortcomings in pain management research.
约半数多发性硬化症（MS）患者报告有疼痛；仅针对疼痛的治疗就占所有用于管理与 MS 相关症状的药物总使用量的近 30%。MS 患者在疾病过程中的任何时候都可能同时经历不止一种类型的疼痛，甚至在新诊断或近期诊断的病例中也是如此。MS 相关的疼痛可能与其他症状相关，包括痉挛、疲劳和情绪障碍。疼痛患者的日常生活活动、工作、情绪、娱乐和整体生活享受都会受到干扰，并报告对疼痛管理的满意度低。疼痛的许多临床特征通常未被临床医生识别，且患者难以描述。大多数治疗相关的临床证据都来自小型的、开放标签的研究；因此，MS 相关疼痛的治疗通常基于经验性报告和临床医生的经验。大多数研究的开放标签设计、缺乏大样本以及由于伦理考虑而难以进行安慰剂对照研究，导致缺乏支持或反驳疼痛药物有效性的充分证据。本综述介绍了针对 MS 疼痛的药物治疗方法的现有数据，并强调了疼痛管理研究的不足。
