Neurogenic Pain in Multiple Sclerosis: A Single Center Comprehensive Pain Assessment
Sheila Steiner1, Giovanna Durman1, M. Paz Soldan1, Sara Woltz1, Ka-Ho Wong2, John Rose3
1University of Utah, 2U of U Neurology Clinic, 3Imaging and Neurosciences Center
Objective:
Our focus was the development of a new pain assessment form to facilitate patient communication, quantify the location and types of pain, identify the pain medications and track patient outcomes.
Background:
Robust literature shows 30-85% of Multiple Sclerosis (MS) patients have reported various types of neurogenic pain.  MS-related neurogenic pain is often coincident with muscle aches, spasms, joint issues, and other non-neurogenic sources.   
Design/Methods:
This is a single-center prospective survey project to characterize MS-related pain. We developed a new assessment that allows patients to differentiate neurogenic from non-neurogenic pain, identify the type of pain they experience, and indicate specific locations and intensity of their pain.  The new form utilizes both traditional 1-10 scales and pictographic representation for both neurogenic and non-neurogenic pain.  Demographics, therapeutics, and management are also recorded.
Results:
We collected data from May, 2017 to October, 2019 on 70 MS patients (mean age 61.3 years, 78.5% female) experiencing neurogenic pain.   Of the 70 patients, average pain score is 7.6±1.8 (range of 2-10), with all showing frequent pain and 3 to 4 types of neurogenic pain along with non-neurogenic pain.  Severity of neurogenic pain types ranged from 6.0 to 7.6 with dysesthesias and electrical pain the most intense.  Overall, opioid use is low (n=13) with the AEDs, gabapentin, pregabalin and oxcarbazepine utilized in the majority of patients (n=51).   This information is utilized to facilitate further management and as a baseline for longitudinal assessments.
Conclusions:

The design and utilization of this form in the clinical setting have definitively facilitated a meaningful patient/physician discussion of pain.  In addition, it has highlighted the high levels of pain, the use of AEDs, and that pain control is often suboptimal.  Utilization of this form in follow up visits and tracking the data longitudinally creates a significant potential to optimize therapies for individual patients.