PAIN AND VERTEBROGENIC SYNDROMES IN PATIENTS WITH MULTIPLE SCLEROSIS (REVIEW OF LITERATURE)

Abstract

Multiple sclerosis (MS) is the most prevalent disease of the central nervous system (CNS), that causes persistent disability of young people at the working age. Among the most frequent MS syndromes are coordinative disorders, visual disturbances, central pareses, pelvic disorders, sense of discomfort, but not pain. It has been established that half of these patients suffer from chronic pain. Very often the pain is the first manifestation of MS (in up to 11% cases). The article presents the features of pain syndromes, as well as spinal diseases as manifestations of comorbid states in MS. We have also analyzed their connection with clinical features of the MS course. The problem of pain syndrome in MS patients becomes more and more important nowadays. Recent studies suggest that at least 2/3 of patients with this ailment have pain to varying degrees and at least 40% of them characterized their pain as persistent one. MS patients in the presence of pain syndrome are more disabled and socially disadapted than those with a similar neurological defect without pain syndrome. Patients with MS presenting with pain syndrome predominantly have headache, pain in the cervical-thoracic and lumbar-sacral spine, and neuropathic pain in the lower limbs. Taking into account the urgency of the problem of pain and vertebrogenic syndromes in demyelinating diseases, it requires close attention and further study. Vertebrogenic syndromes in MS develop due to the influence of several factors, mostly, centers of demyelination, dystrophic changes in the spine and osteoporosis. In MS, vertebrogenic syndromes have their own hallmarks. It is an early onset, a long-term pain without clear periods of deterioration and improvement, moderately evident muscular-tonic disorders that are observed in all parts of the spine. Neurological disorders in MS accelerate development of diverse functional and organic (dystrophic) processes in the spine. Often, vertebrogenic and pain syndromes precede the widespread clinical picture of the disease, when patients for months and years are treated by manual therapists, and sometimes by neurosurgeons. Only a timely observation by neurologist and MRI of the brain and spinal cord can establish the correct diagnosis.

Keywords

• multiple sclerosis, comorbidity, spinal pathology, pain, review of literature