Pellkofer Hannah L, Kümpfel Tania
Institut für Klinische Neuroimmunologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
Schmerz. 2021 Jun;35(3):211-222. doi: 10.1007/s00482-021-00554-5. Epub 2021 May 25.
Multiple sclerosis and neuromyelitis optica spectrum disorders are autoimmune inflammatory diseases of the central nervous system, which can lead to a multitude of neurological complaints and pain syndromes. Pain may be an acute symptom during disease exacerbation as well as a chronic symptom, whereby the latter sometimes substantially reduces the quality of life. The etiology of pain is very heterogeneous but the rapid differential diagnostic classification is decisive in order to be able to initiate a differentiated treatment strategy. Chronic pain must be differentiated from pain as a possible (early) symptom of an acute disease exacerbation, classified in more detail and individually treated. These include central neuropathic pain, pain associated with spasticity, musculoskeletal pain due to excess loading and pain as a side effect of immunotherapy and in the context of comorbidities. The treatment strategies are often insufficiently evidence-based due to the lack of data.
多发性硬化症和视神经脊髓炎谱系障碍是中枢神经系统的自身免疫性炎症性疾病，可导致多种神经症状和疼痛综合征。疼痛可能是疾病加重期间的急性症状，也可能是慢性症状，后者有时会严重降低生活质量。疼痛的病因非常复杂，但快速的鉴别诊断分类对于能够启动差异化的治疗策略至关重要。慢性疼痛必须与作为急性疾病加重可能（早期）症状的疼痛区分开来，进行更详细的分类并进行个体化治疗。这些包括中枢性神经病理性疼痛、与痉挛相关的疼痛、负荷过重引起的肌肉骨骼疼痛以及作为免疫治疗副作用和合并症情况下的疼痛。由于缺乏数据，治疗策略往往缺乏充分的循证依据。
