Schmerzen bei Multipler Sklerose

M. Paulig

doi:10.1055/s-0038-1628699

Nervenheilkunde, Table of Contents

Nervenheilkunde 2009; 28(12): 875-878
DOI: 10.1055/s-0038-1628699

Schwabinger Neuro-Seminar

Schattauer GmbH

Schmerzen bei Multipler Sklerose

Pain and multiple sclerosis

Authors

M. Paulig

¹Abteilung für Neurologie und klinische Neurophysiologie, Neurologisches Krankenhaus München, Schön Kliniken

Abstract

Zusammenfassung

Über viele Jahrzehnte waren Schmerzen ein unterschätztes Problem bei Patienten mit Multipler Sklerose (MS). Neue Studien zeigen eine Prävalenz von schmerzhaften Symptomen von über 80% mit einem erheblichen Einfluss auf Alltagsaktivitäten und Lebensqualität. Schmerzsyndrome können in vier Kategorien bezüglich ihrer Genese klassifiziert werden: 1. Schmerzen direkt durch MS bedingt, z. B. neuropathische Schmerzen; 2. Schmerzen indirekt durch MS bedingt, z. B. Spastik assoziierte Schmerzen; 3. Schmerzen durch MSTherapie, z. B. Nebenwirkungen von Immunmodulanzien; 4. Schmerzen nicht durch MS bedingt. Die Behandlung sollte individuell angepasst erfolgen, wobei im Einzelfall der Nutzen gegen mögliche Nebenwirkungen abzuwägen ist. Speziell bei chronischen Schmerzen ist eine mehrdimensionale Therapie erforderlich, die neben medikamentösen auch nicht medikamentöse Behandlungen wie Physiotherapie oder kognitive Verhaltenstherapie mit einschließt.

Summary

For many decades pain has been an underestimated problem in patients with multiple sclerosis (MS). Recent studies showed a prevalence of painful symptoms up to more than 80% with a high impact on activities of daily life and quality of life. Pain syndromes can be divided into four categories of origin: 1. pain directly related to MS, e. g. neuropathic pain; 2. pain indirectly related to MS, e. g. pain associated with spasticity; 3. pain related to MS therapy, e. g. side effects of disease modifying drugs; 4. pain not related to MS. Therapy should be tailor made weighing the individual benefit against possible side effects. Particularly the treatment of chronic pain requires a multidimensional approach that apart from medication consists of non-pharmacological strategies, like physiotherapy and cognitive behavioural therapy.

Schlüsselwörter

Multiple Sklerose - Schmerz - Behandlung

Keywords

Multiple sclerosis - pain - treatment

Full Text

References

Literatur
1 Archibald CJ. et al. Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients. Pain 1994; 58: 89-93.
2 Brochet B, Deloire MS, Ouallet JC, Salort E, Bonnet M, Jové J, Petry KG. Pain and quality of life in the early stages after multiple sclerosis diagnosis: a 2-year longitudinal study. Clin J Pain 2009; 25 (03) 211-7.
3 Charcot JM. Lecons sur les maladies du systeme nerveux faites a la Salpetriere. Paris: Delahaye 1872
4 Clifford DB, Trotter JL. Pain in multiple sclerosis. Arch Neurol 1984; 41: 1270-2.
5 Etus V. et al. Multiple sclerosis and coexisting intradural extramedullary spinal cord tumor: a case report. Neurol Sci 2002; 23: 119-22.
6 European Multiple Sclerosis Platform. Recommendations on Rehabilitation Services for Persons with Multiple Sclerosis in Europe. Brussels 2004, Belgium..
7 Freal JE, Kraft GH, Coryell JK. Symptomatic fatigue in multiple sclerosis. Arch Phys Med Rehabil 1984; 65: 135-8.
8 Hay MC, Strathmann C, Lieber E, Wick K, Giesser B. Why patients go online: multiple sclerosis, the internet, and physician-patient communication. Neurologist 2008; 14 (06) 374-81.
9 Henze T. Symptomatic treatment of Multiple Sclerosis. Multiple Sclerosis Therapy Consensus Group (MSTCG) of the German Multiple Sclerosis Society. Eur Neurol 2006; 56: 78-105.
10 Hirsh AT, Turner AP, Ehde DM, Haselkorn JK. Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors. Arch Phys Med Rehabil 2009; 90 (04) 646-51.
11 Jensen MP, Barber J, Romano JM, Molton IR, Raichle KA, Osborne TL, Engel JM, Stoelb BL, Kraft GH, Patterson DR. A comparison of self-hypnosis versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain. Int J Clin Exp Hypn 2009; 57 (02) 198-221.
12 Malfitano AM, Proto MC, Bifulco M. Cannabinoids in the management of spasticity associated with multiple sclerosis. Neuropsychiatric Disease and Treatment 2008; 04 (05) 847-53.
13 Motl RW, McAuley E, Snook EM, Gliottoni RC. Physical activity and quality of life in multiple sclerosis: intermediary roles of disability, fatigue, mood, pain, self-efficacy and social support. Psychol Health Med 2009; 14 (01) 111-24.
14 Motl RW, McAuley E. Symptom Cluster as a Predictor of Physical Activity in Multiple Sclerosis:Preliminary Evidence. J Pain Symptom Manage 2009; 38 (02) 270-80.
15 Moulin DE, Foley KM, Ebers GC. Pain syndromes in multiple sclerosis. Neurology 1988; 38: 1830-4.
16 Murphy SM, Rogers A, Hutchinson M, Tubridy N. Counting the cost of complementary and alternative therapies in an Irish neurological clinic. Eur J Neurol 2008; 15 (12) 1380-3.
17 Nicoletti A, Patti F, Lo SFermo, Liberto A, Castiglione A, Laisa P, Garifoli ANaia, La F, Maimone D, Sorbello V, Contrafatto D, Zappia M. Headache and multiple sclerosis: a population-based case-control study in Catania, Sicily. Cephalalgia 2008; 28 (11) 1163-9.
18 Olsen SA. A review of complementary and alternative medicine (CAM) by people with multiple sclerosis. Occup Ther Int 2009; 16 (01) 57-70.
19 Patrick E, Christodoulou C, Krupp LB. New York State MS Consortium. Longitudinal correlates of fatigue in multiple sclerosis. Mult Scler 2009; 15 (02) 258-61.
20 Pöllmann W, Feneberg W, Erasmus LP. Pain in mutliple sclerosis: a still underestimated problem. The 1-year prevalence of pain syndromes, significance and quality of care of multiple sclerosis inpatients. Nervenarzt 2004; 75 (02) 135-40.
21 Pöllmann W, Feneberg W, Steinbrecher A, Haupts MR, Henze T. Therapy of pain syndromes in multiple sclerosis – an overview with evidencebased recommendations. Fortschr Neurol Psychiatr 2005; 73: 268-85.
22 Pöllmann W, Feneberg W. Current management of pain associated with Multiple Sclerosis. CNS Drugs 2008; 22 (04) 291-324.
23 Rossi S, Mataluni G, Codecà C, Fiore S, Buttari F, Musella A, Castelli M, Bernardi G, Centonze D. Effects of levetiracetam on chronic pain in multiple sclerosis: results of a pilot, randomized, placebocontrolled study. Eur J Neurol 2009; 16 (03) 360-6.
24 Solaro C, Brichetto C, Amato M, Cocco E, Colombo B, D’Aleo G, Gasperini C, Grezzi A, Martinelli V, Milanese C, Patti F, Trojano M, Verdun E, Mancardi GL. and the PaIMS Study Group. The prevalence of pain in multiple sclerosis: A multicenter crosssectional study. Neurology 2004; 63: 919-21.
25 Stenager E, Knudsen L, Jensen K. Acute and chronic pain syndromes in multiple sclerosis. Acta Neurol Scand 1991; 84: 197-200.
26 Stenager E, Knudsen L, Jensen KA. cute and chronic pain syndromes in multiple sclerosis. A 5-year follow up study. Ital J Neurol Sci 1995; 16: 529-532.
27 Svendsen KB, Jensen SJ, Overvad K, Hansen HJ, Kock-Henriksen N, Back FW. Pain in patients with multiple sclerosis. Arch Neurol 2003; 60: 1089-94.
28 Twomey JA, Espir MLE. Paroxysmal symptoms as the first manifestations of multiple sclerosis. J Neurol Neurosurg Psychiatry 1980; 43: 296-304.
29 Vermote R, Ketelaer P, Carton H. Pain in multiple sclerosis patients: a prospective study using the McGill Pain Questionnaire. Clin Neurol Neurosurg 1996; 88: 97-93.