Longitudinal prevalence and determinants of pain in multiple sclerosis: results from the German National Multiple Sclerosis Cohort study
Longitudinal prevalence and determinants of pain in multiple sclerosis: results from the German National Multiple Sclerosis Cohort study
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DOI：
10.1097/j.pain.0000000000001767
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发表时间：
2020-04-01
期刊：
影响因子：
7.4
通讯作者：
Ploner, Markus
中科院分区：
文献类型：
--
作者：
Heitmann, Henrik;Haller, Bernhard;Ploner, Markus
疼痛在多发性硬化症(MS)中常见，包括不同的类型，其中神经性疼痛(NP)与MS的病理关系最为密切。然而，患病率估计差异很大，多发性硬化症患者疼痛和生物、心理、社会因素之间的因果关系在很大程度上是未知的。纵向研究可能有助于阐明MS疼痛的患病率和决定因素。为此，我们分析了410名新诊断的临床隔离综合征或复发-缓解型MS患者的数据，这些患者参加了前瞻性多中心德国国家MS队列研究(NationMS)，在基线和4年后。疼痛评估采用PainDETECT问卷进行自我报告。神经精神评估包括疲劳、抑郁和认知测试。此外，还获得了社会人口学和临床数据。在基线和4年后，任何类型疼痛的患病率分别为40%和36%，而NP的患病率分别为2%和5%。任何类型的疼痛和NP都与疲劳、抑郁和残疾密切相关。这种联系在4年后甚至比基线时更强。此外，疼痛、抑郁和疲劳的变化高度相关，而没有任何这些症状先于其他症状。综上所述，在早期非进展性MS中，任何类型的疼痛似乎都比NP更常见。此外，MS中疼痛、疲劳和抑郁之间的密切关系应该被考虑到治疗决策和未来可能的共同病理生理研究。
Pain is frequent in multiple sclerosis (MS) and includes different types, with neuropathic pain (NP) being most closely related to MS pathology. However, prevalence estimates vary largely, and causal relationships between pain and biopsychosocial factors in MS are largely unknown. Longitudinal studies might help to clarify the prevalence and determinants of pain in MS. To this end, we analyzed data from 410 patients with newly diagnosed clinically isolated syndrome or relapsing-remitting MS participating in the prospective multicenter German National MS Cohort Study (NationMS) at baseline and after 4 years. Pain was assessed by self-report using the PainDETECT Questionnaire. Neuropsychiatric assessment included tests for fatigue, depression, and cognition. In addition, sociodemographic and clinical data were obtained. Prevalence of pain of any type was 40% and 36% at baseline and after 4 years, respectively, whereas prevalence of NP was 2% and 5%. Pain of any type and NP were both strongly linked to fatigue, depression, and disability. This link was even stronger after 4 years than at baseline. Moreover, changes in pain, depression, and fatigue were highly correlated without any of these symptoms preceding the others. Taken together, pain of any type seems to be much more frequent than NP in early nonprogressive MS. Moreover, the close relationship between pain, fatigue, and depression in MS should be considered for treatment decisions and future research on a possible common pathophysiology.