Neuropathic Pain in Multiple Sclerosis Patients

Among a multitude of pain syndromes (PS) of diverse locations and types of pathogenesis encountered in multiple sclerosis (MS) patients, most research attention is paid to neuropathic PS, which are not uncommonly present at the early stages of MS, significantly reduce quality of life by producing impairments to patients’ social adaptation, and lead to poor therapeutic responses. The most typical in MS patients are central neuropathic pains, whose pathogenesis is linked with the formation of plaques of demyelination in the CNS. The diagnosis of neuropathic PS in MS is based mainly on the features of the clinical picture; MRI brain scan data and neurophysiological investigations are adjunctive. This review addresses contemporary views of the three main types of neuropathic PS in MS: constant limb pain, trigeminal neuralgia, and Lhermitte’s phenomenon. The clinical manifestations of each of these syndromes are described, along with current views on pathogenesis and data on the informativeness of supplementary investigation methods, and existing approaches to conservative and surgical treatment based on randomized trial data are analyzed.