title: Association of neuromyelitis optica with severe and intractable pain.
abstract: OBJECTIVE
  To contrast differences in pain and treatment outcomes between neuromyelitis optica (NMO) and multiple sclerosis (MS).
  
  
  METHODS
  Retrospective, cross-sectional cohort study.
  
  
  METHODS
  Academic MS center.
  
  
  METHODS
  Complete ascertainment of an academic MS center cohort of NMO and an MS comparison sample cohort.
  
  
  METHODS
  Current pain was quantified by a 10-point scale and the McGill Pain Questionnaire.Expanded Disability Status Scale score and number of involved spinal cord levels were collected in addition to testing for cognition, fatigue, depression, and quality of life. Number and types of pain medications were tabulated.
  
  
  RESULTS
  Current pain was more common in subjects with NMO (n=29) vs MS (n=66) (86.2% vs 40.9%; P.001)and more severe on a 10-point scale (5.38 vs 1.85;P.001). Pain remained more common after controlling for disability and number of spinal cord segments(P=.03). Prescription pain medication was used more frequently in subjects with NMO compared with subjects with MS(75.9% vs 37.8%; P.001), often requiring more than 1 medication (65.5% vs 15.2%; P.001). No subject with NMO taking pain medication (22 of 29) rated their current pain as 0 of 10, whereas almost half of those taking pain medication with MS were currently free of pain (0% vs 48%; P=.006).
  
  
  CONCLUSIONS
  Neuromyelitis optica is frequently associated with severe pain that appears insufficiently controlled by pharmacologic interventions. Future studies should evaluate the efficacy of a multidisciplinary and multimodal approach to pain management.
authors.affiliation: Washington University School of Medicine, St Louis, Missouri, USA. qianp@neuro.wustl.edu
authors.forename: Peiqing
authors.initials: P
authors.lastname: Qian
authors.forename: Samantha
authors.initials: S
authors.lastname: Lancia
authors.forename: Enrique
authors.initials: E
authors.lastname: Alvarez
authors.forename: Eric C
authors.initials: EC
authors.lastname: Klawiter
authors.forename: Anne H
authors.initials: AH
authors.lastname: Cross
authors.forename: Robert T
authors.initials: RT
authors.lastname: Naismith
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis; D009471:Neuromyelitis Optica / Q000150:complications* / Q000175:diagnosis; D059408:Pain Management; D010147:Pain Measurement; D010148:Intractable Pain / Q000150:complications* / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013116:Spinal Cord / Q000473:pathology; D018709:Statistics, Nonparametric