title: Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis.
abstract: The prevalence, associations, and natural history of pain in multiple sclerosis (MS) are poorly understood. The objective of this work was to study the prevalence of pain syndromes in MS both cross-sectionally, and longitudinally during the MS disease course. We systematically identified prospective studies detailing pain prevalence in definite MS. We used pooled prevalence estimates, explored heterogeneity using meta-regression, and analysed prevalence during the disease course using both estimates at disease milestones and longitudinal studies. Twenty-eight articles (7101 subjects) describing overall pain, or pain syndromes, met inclusion criteria. Pooled overall pain prevalence (17 studies, 5319 subjects) was 63% (95% confidence interval [CI] 55-70%). Marked heterogeneity in this estimate was not significantly explained by selected study design variables (use of outpatient sample, timeframe prior to study over which pain was assessed) or sample demographic variables (mean Expanded Disability Status Scale, mean disease duration, proportion of female sex, and proportion with progressive MS). We quantified prevalence of headache (43%; 95% CI 33-52%), neuropathic extremity pain (26%; 95% CI 7-53%), back pain (20%; 95% CI 13-28%), painful spasms (15%; 95% CI 8.5-23%), Lhermitte sign (16%; 95% CI 10-25%), and trigeminal neuralgia (3.8%; 95% CI 2-6%) in included studies. Prevalence of pain at MS disease milestones (prior to onset, at onset, and at relapse) and during longitudinal follow-up was poorly described. Pain is common in MS, as are specific pain syndromes. The clinical associations and natural history of pain in MS require clarification. Future study could be enhanced by standardised study design.
authors: Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK Department of Palliative Medicine, Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK European Palliative Care Research Centre (PRC), Norwegian University of Science and Technology, Trondheim, Norway The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Heidelberg, Australia Department of Anaesthesia and Pain Medicine, University of Edinburgh, Edinburgh, UK.
authors: Peter L
authors: PL
authors: Foley
authors: Hanna M
authors: HM
authors: Vesterinen
authors: Barry J
authors: BJ
authors: Laird
authors: Emily S
authors: ES
authors: Sena
authors: Lesley A
authors: LA
authors: Colvin
authors: Siddharthan
authors: S
authors: Chandran
authors: Malcolm R
authors: MR
authors: MacLeod
authors: Marie T
authors: MT
authors: Fallon
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D018450:Disease Progression; D006261:Headache / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008137:Longitudinal Studies; D009103:Multiple Sclerosis / Q000150:complications*; D009437:Neuralgia / Q000453:epidemiology / Q000209:etiology; D010146:Pain / Q000453:epidemiology* / Q000209:etiology*; D010147:Pain Measurement; D015995:Prevalence; D012008:Recurrence; D012044:Regression Analysis; D012737:Sex Factors; D013035:Spasm / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D014277:Trigeminal Neuralgia / Q000453:epidemiology / Q000209:etiology