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Characterization of pain syndromes in patients with neuromyelitis optica
Author(s) -
Valerio Fernanda,
ApostolosPereira Samira L.,
Sato Douglas Kazutoshi,
Callegaro Dagoberto,
Lucato Leandro Tavares,
Barboza Victor Rosseto,
Silva Valquiria A.,
Galhardoni Ricardo,
Rodrigues Antonia L. de Lima,
Jacobsen Teixeira Manoel,
Ciampi de Andrade Daniel
Publication year - 2020
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.1608
Subject(s) - medicine , neuropathic pain , neuromyelitis optica , pain catastrophizing , physical therapy , fibromyalgia , quality of life (healthcare) , chronic pain , anesthesia , multiple sclerosis , psychiatry , nursing
Abstract Background Pain is common and refractory in spinal cord injury (SCI). Currently, most studies evaluated pain in male‐predominant traumatic‐SCI. Also, concomitant secondary pain syndromes and its temporal evolution were seldom reported.Methods We aimed to prospectively describe the main and secondary pain and its associated factors in inflammatory‐SCI evaluating neuromyelitis optica (NMO) patients. In‐remission NMO patients underwent neurological, imaging and autoantibody evaluations. Questionnaires detailing main and secondary pains, functional state, mood, catastrophizing, quality of life (QoL) and “non‐motor symptoms" were used at two time points. Results Pain was present in 53 (73.6%) of the 72 patients included. At‐level neuropathic pain was the most common main pain syndrome, affecting 32 subjects (60.4% of those with pain). Over 70% ( n = 38) of this cohort reported two pain syndromes. Those without pain were significantly younger (26.1 ± 12.7 y.o. in those without pain and 40.1 ± 12.5, 37.2 ± 11.4 y.o. in those whose main pain was neuropathic and non‐neuropathic, respectively, p = .001), and no differences in the inflammatory status were observed between groups. On follow‐up, one‐fifth ( n = 11) had a different main pain syndrome from the first visit. Pain impacted QoL as much as disability and motor strength. Conclusion Pain is a prevalent and disabling non‐motor symptom in NMO‐SCI. Most patients experience more than one pain syndrome which can change in time even in the absence of clinical relapse. Age of the inflammatory‐SCI was a major determinant of pain. Acknowledging temporal changes and multiplicity of pain syndromes in NMO‐SCI may give insights into more precise designs of clinical trials and general management of pain in SCI. Significance In this longitudinal study with NMO‐related SCI, pain affected almost three‐quarters of patients with NMO. Over 70% have more than one pain syndrome and at‐level neuropathic pain is the most common type of pain syndrome. Patients without pain were significantly younger but had the same burden of inflammatory lesions than those with pain. During follow‐up, up to one fifth of patients presented with changes in the main pain syndromes, which can occur even in the absence of clinical activity of the inflammatory disease. In this cohort, Pain affected quality of life as much as disability or motor strength.