Department of Human Neuroscience, Sapienza University, viale Università 30, 00185, Rome, Italy.
CNS Drugs. 2020 Jul;34(7):749-761. doi: 10.1007/s40263-020-00731-7.
Pain is a major matter for patients with multiple sclerosis; treatment response is frequently inadequate, with a significant impact on quality of life. The estimated prevalence of pain in multiple sclerosis ranges widely (26-86%), and different subtypes of pain, mediated by specific pathophysiological mechanisms, are described. The aim of this narrative review, performed using a systematic search methodology, was to provide current, evidence-based, knowledge about the pharmacological treatment of the different kinds of pain in multiple sclerosis. We searched for relevant papers within PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Clinical Trials database (ClinicalTrials.gov), considering publications up to November 2019. Two authors independently selected studies for inclusion, data extraction, and bias assessment. A total of 27 randomized controlled trials were identified, but in only a few cases, patients with different pain qualities were stratified. Following a mechanism-based approach, treatment of paroxysmal pain and painful tonic spasms should be based on sodium-channel blockers, whereas treatment of ongoing extremity pain should be based on gabapentinoids and antidepressants.
疼痛是多发性硬化症患者的主要问题；治疗反应常常不充分，对生活质量有重大影响。多发性硬化症疼痛的估计患病率差异很大（26-86%），并描述了由特定病理生理机制介导的不同类型的疼痛。本叙述性综述使用系统搜索方法进行，旨在提供关于多发性硬化症中不同类型疼痛的药物治疗的最新循证知识。我们在 PubMed、EMBASE、Cochrane 系统评价数据库和临床试验数据库（ClinicalTrials.gov）中搜索了相关论文，考虑了截至 2019 年 11 月的出版物。两名作者独立选择研究进行纳入、数据提取和偏倚评估。共确定了 27 项随机对照试验，但在少数情况下，对不同疼痛质量的患者进行了分层。基于基于机制的方法，阵发性疼痛和痉挛性疼痛的治疗应基于钠通道阻滞剂，而持续性肢体疼痛的治疗应基于加巴喷丁类药物和抗抑郁药。
