Title:Managing Neuropathic Pain in Multiple Sclerosis: Pharmacological Interventions
Volume: 14
Issue: 2
Author(s): Samuel S. Duffy, Justin G. Lees, Chamini J. Perera and Gila Moalem-Taylor*
Affiliation:
- School of Medical Sciences, the University of New South Wales, UNSW Australia, Sydney, NSW 2052,Australia
Keywords:
Central extremity pain, experimental autoimmune encephalomyelitis, Lhermitte's phenomenon, multiple sclerosis,
neuropathic pain, trigeminal neuralgia.
Abstract: Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of
the central nervous system (CNS). Of the plethora of motor and sensory disturbances experienced by
sufferers, neuropathic pain is a highly prevalent and debilitating symptom, and at present remains extremely
difficult to treat. Common forms of neuropathic pain seen in MS patients include central neuropathic
pain, Lhermitte's phenomenon and trigeminal neuralgia, which are all speculated to arise from
specific patterns of lesion formation.
Objective: Efficacious pharmacological interventions for the treatment of neuropathic pain associated
with MS are lacking, and have been largely informed by drug trials in peripheral neuropathies and spinal
cord injury.
Method/Results: Neuropathic pain in MS is inadequately relieved by conventional analgesics, and
first-line therapies are generally comprised of anti-depressive and anti-convulsive drugs. A range of
alternatives have been proposed and tested with variable success, including cannabinoids and certain
opioid analgesics. Animals with experimental autoimmune encephalomyelitis (EAE), an autoimmune
model of MS, also exhibit neuropathic pain symptoms.
Conclusion: Studies aimed at understanding the mechanisms underlying EAE-induced neuropathic
pain and investigating the efficacy of novel pharmacological interventions at the animal level offer an
exciting area of future research, and may inform future therapeutic options for MS-associated neuropathic
pain.
