title: Chronic neuropathic pain severity is determined by lesion level in aquaporin 4-antibody-positive myelitis.
abstract: OBJECTIVE
  Chronic, intractable neuropathic pain is a common and debilitating consequence of neuromyelitis optica spectrum disorder (NMOSD) myelitis, with no satisfactory treatment; few studies have yet to explore its aetiology.
  
  
  OBJECTIVE
  To establish if myelitis-associated chronic pain in NMOSD is related to the craniocaudal location of spinal cord lesions.
  
  
  METHODS
  (1) Retrospective cohort of 76 aquaporin 4-antibody (AQP4-Ab)-positive patients from Oxford and Liverpool's national NMOSD clinics, assessing current pain and craniocaudal location of cord lesion contemporary to pain onset. (2) Focused prospective study of 26 AQP4-Ab-positive Oxford patients, a subset of the retrospective cohort, assessing current craniocaudal lesion location and current pain.
  
  
  RESULTS
  Patients with isolated thoracic cord myelitis at the time of pain onset were significantly more disabled and suffered more pain. Cervical and thoracic lesions that persisted from pain onset to 'out of relapse' follow-up (current MRI) had highly significant (p<0.01) opposing effects on pain scores (std. β=-0.46 and 0.48, respectively). Lesion length, total lesion burden and number of transverse myelitis relapses did not correlate with pain.
  
  
  CONCLUSIONS
  Persistent, caudally located (ie, thoracic) cord lesions in AQP4-Ab-positive patients associate with high postmyelitis chronic pain scores, irrespective of number of myelitis relapses, lesion length and lesion burden. Although disability correlated with pain in isolation, it became an insignificant predictor of pain when analysed alongside craniocaudal location of lesions.
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.
authors.forename: George
authors.initials: G
authors.lastname: Tackley
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.|Department of Neurology, University of Piemonte Orientale, Novara, Italy.
authors.forename: Domizia
authors.initials: D
authors.lastname: Vecchio
authors.affiliation: Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
authors.forename: Shahd
authors.initials: S
authors.lastname: Hamid
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.
authors.forename: Maciej
authors.initials: M
authors.lastname: Jurynczyk
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.
authors.forename: Yazhuo
authors.initials: Y
authors.lastname: Kong
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.
authors.forename: Rosie
authors.initials: R
authors.lastname: Gore
authors.affiliation: Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
authors.forename: Kerry
authors.initials: K
authors.lastname: Mutch
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodhall
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Waters
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Vincent
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Leite
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.
authors.forename: Irene
authors.initials: I
authors.lastname: Tracey
authors.affiliation: Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
authors.forename: Anu
authors.initials: A
authors.lastname: Jacob
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Palace
mesh_terms: D000328:Adult; D000368:Aged; D051401:Aquaporin 4 / Q000276:immunology*; D001323:Autoantibodies; D059350:Chronic Pain / Q000000981:diagnostic imaging* / Q000209:etiology / Q000276:immunology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000276:immunology; D009471:Neuromyelitis Optica / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology; D010147:Pain Measurement; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013116:Spinal Cord / Q000000981:diagnostic imaging*
chemical_list: D051401:Aquaporin 4; D001323:Autoantibodies