Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK Department of Palliative Medicine, Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK European Palliative Care Research Centre (PRC), Norwegian University of Science and Technology, Trondheim, Norway The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Heidelberg, Australia Department of Anaesthesia and Pain Medicine, University of Edinburgh, Edinburgh, UK.
Pain. 2013 May;154(5):632-642. doi: 10.1016/j.pain.2012.12.002. Epub 2012 Dec 14.
The prevalence, associations, and natural history of pain in multiple sclerosis (MS) are poorly understood. The objective of this work was to study the prevalence of pain syndromes in MS both cross-sectionally, and longitudinally during the MS disease course. We systematically identified prospective studies detailing pain prevalence in definite MS. We used pooled prevalence estimates, explored heterogeneity using meta-regression, and analysed prevalence during the disease course using both estimates at disease milestones and longitudinal studies. Twenty-eight articles (7101 subjects) describing overall pain, or pain syndromes, met inclusion criteria. Pooled overall pain prevalence (17 studies, 5319 subjects) was 63% (95% confidence interval [CI] 55-70%). Marked heterogeneity in this estimate was not significantly explained by selected study design variables (use of outpatient sample, timeframe prior to study over which pain was assessed) or sample demographic variables (mean Expanded Disability Status Scale, mean disease duration, proportion of female sex, and proportion with progressive MS). We quantified prevalence of headache (43%; 95% CI 33-52%), neuropathic extremity pain (26%; 95% CI 7-53%), back pain (20%; 95% CI 13-28%), painful spasms (15%; 95% CI 8.5-23%), Lhermitte sign (16%; 95% CI 10-25%), and trigeminal neuralgia (3.8%; 95% CI 2-6%) in included studies. Prevalence of pain at MS disease milestones (prior to onset, at onset, and at relapse) and during longitudinal follow-up was poorly described. Pain is common in MS, as are specific pain syndromes. The clinical associations and natural history of pain in MS require clarification. Future study could be enhanced by standardised study design.
多发性硬化症（MS）中疼痛的流行率、关联和自然史了解甚少。这项工作的目的是研究 MS 中疼痛综合征的现患率，包括横断面研究和 MS 病程中的纵向研究。我们系统地确定了详细描述明确 MS 中疼痛流行率的前瞻性研究。我们使用汇总的现患率估计值，通过荟萃回归分析探讨异质性，并使用疾病里程碑处的估计值和纵向研究分析疾病过程中的现患率。有 28 篇文章（7101 名受试者）描述了整体疼痛或疼痛综合征，符合纳入标准。汇总的总体疼痛现患率（17 项研究，5319 名受试者）为 63%（95%置信区间[CI] 55-70%）。该估计值存在明显的异质性，但无法通过所选研究设计变量（门诊样本的使用、在评估疼痛之前的研究时间段）或样本人口统计学变量（扩展残疾状况量表的平均值、疾病持续时间的平均值、女性比例和进展性 MS 的比例）得到很好的解释。我们量化了头痛（43%；95%CI 33-52%）、周围神经病变性肢体疼痛（26%；95%CI 7-53%）、背痛（20%；95%CI 13-28%）、痉挛性疼痛（15%；95%CI 8.5-23%）、莱尔米特征（16%；95%CI 10-25%）和三叉神经痛（3.8%；95%CI 2-6%）在纳入研究中的现患率。MS 疾病里程碑处（发病前、发病时和复发时）和纵向随访期间疼痛的现患率描述较差。疼痛在 MS 中很常见，特定的疼痛综合征也是如此。MS 中疼痛的临床关联和自然史需要进一步阐明。未来的研究可以通过标准化的研究设计得到加强。
