Department of Physical Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
J Neurol. 2024 Feb;271(2):688-698. doi: 10.1007/s00415-023-12048-8. Epub 2023 Oct 24.
Central neuropathic pain (CNP) and musculoskeletal pain (MSP) are often comorbid with multiple sclerosis (MS), yet data on the emotional burden entailed by this comorbidity are very limited. We studied whether MS patients with CNP exhibited greater emotional burden and pain severity than those with MSP and whether this emotional burden was attributed to the MS, the chronic pain, or both. Participants were 125 MS patients (55 with CNP; 30 with MSP; 40 MS pain-free) and 30 healthy controls (HCs). Participants completed questionnaires assessing pain interference, pain catastrophizing, depression, anxiety, stress, hypervigilance, and chronic pain. Group comparisons and a two-step cluster analysis were performed, and the association between cluster membership and clinical group membership was evaluated. Chronic pain was stronger and more widespread in the CNP group than in the MSP group. Both pain groups had higher pain interference, pain catastrophizing, and stress compared to MS pain-free and HC groups. All MS groups had greater depression levels compared to HCs, and the CNP group had the highest anxiety level. The "high psychological distress" cluster comprised mainly participants with CNP (57%), and the "minimal psychological distress" cluster comprised mainly the MS pain-free and HC groups. In conclusion, CNP seems to induce greater emotional burden and pain severity than does MSP. Whereas depression may be attributed to MS, and anxiety to CNP, enhanced pain interference, catastrophizing, and stress may be attributed to the comorbidity of MS and chronic pain. Identifying these traits among MS patients and targeting them in management programs may contribute to more effective, individually based care.
中枢神经性疼痛（CNP）和肌肉骨骼疼痛（MSP）常与多发性硬化症（MS）并存，但关于这种共病带来的情绪负担的数据非常有限。我们研究了患有 CNP 的 MS 患者是否表现出比患有 MSP 的患者更大的情绪负担和更严重的疼痛，以及这种情绪负担是归因于 MS、慢性疼痛还是两者兼而有之。参与者为 125 名 MS 患者（55 名患有 CNP；30 名患有 MSP；40 名 MS 无痛）和 30 名健康对照者（HCs）。参与者完成了评估疼痛干扰、疼痛灾难化、抑郁、焦虑、压力、过度警觉和慢性疼痛的问卷。进行了组间比较和两步聚类分析，并评估了聚类成员与临床组成员之间的关联。与 MSP 组相比，CNP 组的慢性疼痛更强烈且更广泛。与 MS 无痛和 HC 组相比，两组疼痛患者的疼痛干扰、疼痛灾难化和压力都更高。与 HCs 相比，所有 MS 组的抑郁水平都更高，而 CNP 组的焦虑水平最高。“高心理困扰”聚类主要由 CNP 患者（57%）组成，“最小心理困扰”聚类主要由 MS 无痛和 HC 组组成。总之，CNP 似乎比 MSP 引起更大的情绪负担和更严重的疼痛。尽管抑郁可能归因于 MS，焦虑可能归因于 CNP，但增强的疼痛干扰、灾难化和压力可能归因于 MS 和慢性疼痛的共病。在 MS 患者中识别这些特征，并在管理计划中针对这些特征进行治疗，可能有助于提供更有效、个体化的护理。
