An update on the pharmacological management of pain in patients with multiple sclerosis

被引:16
|
作者
Chisari, Clara G. [1 ]
Sgarlata, Eleonora [2 ,3 ]
Arena, Sebastiano [1 ]
D'Amico, Emanuele [1 ]
Toscano, Simona [1 ]
Patti, Francesco [1 ]
机构
[1] Univ Catania, Dept GF Ingrassia, Sect Neurosci, Via S Sofia 78, I-95129 Catania, Italy
[2] Sapienza Univ Rome, Dept Neurol & Psychiat, Rome, Italy
[3] Umberto I Hosp, Dept Med, Stroke Unit, Siracusa, Italy
关键词
Multiple sclerosis; pain management; drugs; non pharmacological treatments; PLACEBO-CONTROLLED TRIAL; QUALITY-OF-LIFE; TRIGEMINAL NEURALGIA; DOUBLE-BLIND; INTRATHECAL BACLOFEN; OROMUCOSAL SPRAY; NEUROPATHIC PAIN; BOTULINUM TOXIN; PILOT TRIAL; SPINAL-CORD;
D O I
10.1080/14656566.2020.1757649
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Introduction: The prevalence of pain in Multiple Sclerosis (MS) is estimated to be between 29-86% depending on various stages of the disease. According to a recent mechanism-based classification, MS pain syndromes include ongoing extremity pain, trigeminal neuralgia, and Lhermitte's phenomenon, painful tonic spasms and spasticity pain, pain associated with optic neuritis, musculoskeletal pain, migraine, and treatment-induced pain. Area covered: Pharmacological approaches for MS pain include anticonvulsants, antidepressants, botulinum toxin, cannabinoids, muscle relaxants, opioid analgesics, and intrathecally administered baclofen. It has been reported that pharmacological treatments have poor efficacy and alarming side effects. For these reasons, non-pharmacological interventions, either alone or in combination with pharmacological treatments are commonly used in clinical practice. Examples of these interventions include electrical or chemical neurostimulation therapy, exercise, and psychological approaches. This is discussed in more detail herein. Expert opinion: The management of MS pain can be challenging due to the natural course of the disease and the lack of a definite cure. Recommendations based on rigorous scientific methods for MS pain treatment are unavailable. Thus, clinicians should consider available treatment regimens based on efficacy, safety, cost, and the clinical complexity of the patient. The use of therapeutic approaches combining pharmacological and non-pharmacological treatments may help to reduce the risk of overuse and mitigate the complaint of simultaneous and multiple therapies.
引用
收藏
页码:2249 / 2263
页数:15
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