Pain in Guillain-Barre syndrome: a long-term follow-up study.
BACKGROUND
Pain in Guillain-Barré syndrome (GBS) may be pronounced and is often overlooked.


OBJECTIVE
To obtain detailed information about pain in GBS and its clinical variants.


METHODS
This was a prospective cohort study in 156 patients with GBS (including 18 patients with Miller Fisher syndrome [MFS]). We assessed the location, type, and intensity of pain using questionnaires at standard time points during a 1-year follow-up. Pain data were compared to other clinical features and serology.


RESULTS
Pain was reported in the 2 weeks preceding weakness in 36% of patients, 66% reported pain in the acute phase (first 3 weeks after inclusion), and 38% reported pain after 1 year. In the majority of patients, the intensity of pain was moderate to severe. Longitudinal analysis showed high mean pain intensity scores during the entire follow-up. Pain occurred in the whole spectrum of GBS. The mean pain intensity was predominantly high in patients with GBS (non-MFS), patients with sensory disturbances, and severely affected patients. Only during later stages of disease, severity of weakness and disability were significantly correlated with intensity of pain.


CONCLUSIONS
Pain is a common and often severe symptom in the whole spectrum of GBS (including MFS, mildly affected, and pure motor patients). As it frequently occurs as the first symptom, but may even last for at least 1 year, pain in GBS requires full attention. It is likely that sensory nerve fiber involvement results in more severe pain.
Ruts
L
L
Erasmus MC, University Medical Center, Department of Neurology, Room BA-450, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands. l.ruts@erasmusmc.nl
Drenthen
J
J
Jongen
J L M
JL
Hop
W C J
WC
Visser
G H
GH
Jacobs
B C
BC
van Doorn
P A
PA
D000200:Action Potentials / Q000502:physiology; D000328:Adult; D000906:Antibodies / Q000097:blood; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004185:Disability Evaluation; D004576:Electromyography / Q000379:methods; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005732:Gangliosides / Q000276:immunology; D020275:Guillain-Barre Syndrome / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D010147:Pain Measurement / Q000379:methods; D011930:Reaction Time / Q000502:physiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013997:Time Factors
D000906:Antibodies; D005732:Gangliosides