medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-023medsovet-9000Research ArticleТЕРАПИЯ БОЛИPAIN THERAPYКлинико-радиологические характеристики центрального болевого синдрома при демиелинизирующих заболеваниях с поражением спинного мозгаClinical and radiological characteristics of central pain in demyelinating diseases with spinal cord lesionshttps://orcid.org/0000-0001-5008-1265ЕрмиловаЕ. В.ErmilovaE. V.

Ермилова Елизавета Викторовна - соискатель ученой степени кандидата медицинских наук кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского.

119021, Москва, ул. Россолимо, д. 11, стр. 1

Elizaveta V. Ermilova - Candidate of the Degree of Cand. Sci. (Med.), Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine.

11, Bldg. 1, Rossolimo St., Moscow, 119435

Dr.ermilovaneuro@yandex.ruhttps://orcid.org/0000-0002-7330-633XВоскресенскаяО. Н.VoskresenskayaO. N.

Воскресенская Ольга Николаевна - д.м.н., профессор кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского.

119021, Москва, ул. Россолимо, д. 11, стр. 1

Olga N. Voskresenskaya - Dr. Sci. (Med.), Professor of the Department of Nervous Diseases and Neurosurgery at the N.V. Sklifosovsky Institute of Clinical Medicine.

11, Bldg. 1, Rossolimo St., Moscow, 119435

vos-olga@yandex.ruhttps://orcid.org/0000-0001-8039-9194НабиевШ. Р.NabievSh. R.

Набиев Шихмирза Рагибович - заведующий первым неврологическим отделением Клиники нервных болезней имени А.Я. Кожевникова Университетской клинической больницы №3.

119021, Москва, ул. Россолимо, д. 11, стр. 1

Shikhmirza R. Nabiev - Head of the First Neurological Department of the Kozhevnikov Nervous Diseases Clinic of the University Clinical Hospital No. 3.

11, Bldg. 1, Rossolimo St., Moscow, 119435

nabievmd@gmail.comПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202512042025039095Copyright © Ермилова Е.В., Воскресенская О.Н., Набиев Ш.Р., 20252025Ермилова Е.В., Воскресенская О.Н., Набиев Ш.Р.Ermilova E.V., Voskresenskaya O.N., Nabiev S.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9000Введение

Введение. В структуре симптомов демиелинизирующих заболеваний боль занимает одну из главенствующих позиций. Выявление возможной взаимосвязи между размерами, локализацией очагов демиелинизации и возникновением центрального невропатического болевого синдрома представляет научный и клинический интерес.

Цель

Цель. Изучить клинико-радиологические характеристики центрального невропатического болевого синдрома при демиелинизирующих заболеваниях с поражением спинного мозга.

Материалы и методы

Материалы и методы. Обследованы 52 пациента с поражением спинного мозга при рассеянном склерозе и заболеваниях спектра нейрооптикомиелита. Все пациенты были разделены на две группы: с болевым синдромом (n = 25, из них 12 пациентов с рассеянным склерозом и 13 – с заболеваниями спектра нейрооптикомиелита) и без болевого синдрома (n = 27, из них 16 больных с рассеянным склерозом, 11 – с заболеваниями спектра нейрооптикомиелита). Пациенты проходили стандартное интервьюирование, оценку интенсивности боли проводили по 10-балльной визуальной аналоговой шкале, заполняли опросники DN4 (шкала оценки наличия невропатического болевого синдрома). Проводилась оценка степени инвалидизации по расширенной шкале статуса инвалидизации (EDSS). Для топической диагностики очагов поражения проводился анализ МРТ ЦНС сроком до 1 года, мощностью томографа не менее 1,5 Тс.

Результаты

Результаты. Интенсивность болевого синдрома у пациентов с заболеваниями спектра нейрооптикомиелита была выше, чем у пациентов с рассеянным склерозом (p = 0,011). Болевой синдром статистически чаще возникал при дорсолатеральном расположении очагов демиелинизации (p = 0,019) и не зависел от их размеров.

Выводы

Выводы. Механизмы формирования болевого синдрома при заболеваниях спектра нейрооптикомиелита и рассеянном склерозе с поражением спинного мозга не могут быть объяснены только характеристиками самих очагов и нуждаются в дальнейшем изучении.

Introduction

Introduction. Pain is a prominent feature of demyelinating diseases. The identification of potential associations between the size and localisation of demyelinating lesions in spinal cord and the development of central neuropathic pain has scientific and clinical significance.

Aim

Aim. To investigate the clinical and radiological characteristics of central neuropathic pain in demyelinating diseases affecting the spinal cord.

Materials and methods

Materials and methods. A total of 52 patients with spinal cord involvement in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) were examined. Participants were divided into two groups: with pain (n = 25, including 12 patients with MS and 13 with NMOSD) and without pain (n = 27, including 16 patients with MS and 11 with NMOSD). Standardized interviews were conducted, pain intensity was assessed using a 10-point Visual Analog Scale (VAS), and participants completed the DN4 questionnaire. The degree of disability was assessed using the Expanded Disability Status Scale (EDSS). For lesion localization, CNS MRI data were analyzed (MRI scanners with a field strength of ≥ 1.5 T, with imaging conducted within one year). Statistical analyses were performed using SPSS Statistics.

Results

Results. Pain intensity was higher in patients with NMOSD compared to MS (p = 0.011). Pain was more frequent with dorsolateral localization of demyelinating lesions (p = 0.019) and was not associated with lesion size.

Conclusion

Conclusion. The mechanisms underlying pain syndrome in NMOSD and MS with spinal cord involvement cannot be fully explained by lesion characteristics alone and require further investigation.

демиелинизирующие заболеваниярассеянный склероззаболевания спектра нейрооптикомиелитамагнитно-резонансная томографияцентральный невропатический болевой синдромdemyelinating diseasesmultiple sclerosisneuromyelitis optica spectrum disordersmagnetic resonance imagingcentral neuropathic painReferencesJarius S, Aktas O, Ayzenberg I, Bellmann-Strobl J, Berthele A, Giglhuber K et al. Update on the diagnosis and treatment of neuromyelitsoptica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis. J Neurol. 2023;270(7):3341–3368. https://doi.org/10.1007/s00415-023-11634-0.Jarius S, Aktas O, Ayzenberg I, Bellmann-Strobl J, Berthele A, Giglhuber K et al. Update on the diagnosis and treatment of neuromyelitsoptica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis. J Neurol. 2023;270(7):3341–3368. https://doi.org/10.1007/s00415-023-11634-0.Flanagan EP. Autoimmune myelopathies. Handb Clin Neurol. 2016;133:327–351. https://doi.org/10.1016/B978-0-444-63432-0.00019-0.Flanagan EP. Autoimmune myelopathies. Handb Clin Neurol. 2016;133:327–351. https://doi.org/10.1016/B978-0-444-63432-0.00019-0.Finnerup NB, Gyldensted C, Nielsen E, Kristensen AD, Bach FW, Jensen TS. MRI in chronic spinal cord injury patients with and without central pain. Neurology. 2003;61(11):1569–1575. https://doi.org/10.1212/01.wnl.0000096016.29134.fa.Finnerup NB, Gyldensted C, Nielsen E, Kristensen AD, Bach FW, Jensen TS. MRI in chronic spinal cord injury patients with and without central pain. Neurology. 2003;61(11):1569–1575. https://doi.org/10.1212/01.wnl.0000096016.29134.fa.Ермилова ЕВ, Воскресенская ОН, Оспельникова ТП, Шитова АД. Клинические особенности болевого синдрома при демиелинизирующих заболеваниях с поражением спинного мозга. Доктор.Ру. 2022;21(4):19–23. https://doi.org/10.31550/1727-2378-2022-21-4-19-23.Ermilova EV, Voskresenskaya ON, Ospelnikova TP, Shitova AD. Clinical Features of Pain Syndrome in Demyelinating Diseases with Spinal Cord Injury. Doctor.Ru. 2022;21(4):19–23. (In Russ.) https://doi.org/10.31550/1727-2378-2022-21-4-19-23.Wasner G, Lee BB, Engel S, McLachlan E. Residual spinothalamic tract pathways predict development of central pain after spinal cord injury. Brain. 2008;131(9):2387–2400. https://doi.org/10.1093/brain/awn169.Wasner G, Lee BB, Engel S, McLachlan E. Residual spinothalamic tract pathways predict development of central pain after spinal cord injury. Brain. 2008;131(9):2387–2400. https://doi.org/10.1093/brain/awn169.Breckwoldt MO, Gradl J, Hähnel S, Hielscher T, Wildemann B, Diem R et al. Increasing the sensitivity of MRI for the detection of multiple sclerosis lesions by long axial coverage of the spinal cord: a prospective study in 119 patients. J Neurol. 2017;264(2):341–349. https://doi.org/10.1007/s00415-016-8353-3.Breckwoldt MO, Gradl J, Hähnel S, Hielscher T, Wildemann B, Diem R et al. Increasing the sensitivity of MRI for the detection of multiple sclerosis lesions by long axial coverage of the spinal cord: a prospective study in 119 patients. J Neurol. 2017;264(2):341–349. https://doi.org/10.1007/s00415-016-8353-3.Galler S, Stellmann JP, Young KL, Kutzner D, Heesen C, Fiehler J, Siemonsen S. Improved Lesion Detection by Using Axial T2-Weighted MRI with Full Spinal Cord Coverage in Multiple Sclerosis. AJNR Am J Neuroradiol. 2016;37(5):963–969. https://doi.org/10.3174/ajnr.A4638.Galler S, Stellmann JP, Young KL, Kutzner D, Heesen C, Fiehler J, Siemonsen S. Improved Lesion Detection by Using Axial T2-Weighted MRI with Full Spinal Cord Coverage in Multiple Sclerosis. AJNR Am J Neuroradiol. 2016;37(5):963–969. https://doi.org/10.3174/ajnr.A4638.Cacciaguerra L, Sechi E, Rocca MA, Filippi M, Pittock SJ, Flanagan EP. Neuroimaging features in inflammatory myelopathies: A review. Front Neurol. 2022;13:993645. https://doi.org/10.3389/fneur.2022.993645.Cacciaguerra L, Sechi E, Rocca MA, Filippi M, Pittock SJ, Flanagan EP. Neuroimaging features in inflammatory myelopathies: A review. Front Neurol. 2022;13:993645. https://doi.org/10.3389/fneur.2022.993645.Белова АН, Бойко АН, Белова ЕМ. Диагностические критерии оптикомиелит-ассоциированных расстройств. Журнал неврологии и психиатрии им. С.С. Корсакова. 2016;116(2-2):32–40. https://doi.org/10.17116/jnevro20161162232-40.Belova AN, Boiko AN, Belova EM. Diagnostic criteria for neuromyelitisoptica spectrum disorders. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2016;116(2-2):32–40. (In Russ.) https://doi.org/10.17116/jnevro20161162232-40.Симанив ТО, Бахтиярова КЗ, Белова АН, Гончарова ЗА, Сиверцева СА, Спирин НН и др. Заболевания спектра оптиконевромиелита (ЗСОНМ) – диагностические критерии и подходы к терапии. Неврология, нейропсихиатрия, психосоматика. 2023;(15):71–75. https://doi.org/10.14412/20742711-2023-1S-71-75.Simaniv TO, Bakhtiyarova KZ, Belova AN, Goncharova ZA, Sivertseva SA, Spirin NN et al. Diagnostic criteria and treatment of neuromyelitis optica spectrum disorders (NMOSD). Neurology, Neuropsychiatry, Psychosomatics. 2023;(15):71–75. (In Russ.) https://doi.org/10.14412/2074-2711-2023-1S-71-75.Breckwoldt MO, Gradl J, Hähnel S, Hielscher T, Wildemann B, Diem R et al. Increasing the sensitivity of MRI for the detection of multiple sclerosis lesions by long axial coverage of the spinal cord: a prospective study in 119 patients. J Neurol. 2017;264(2):341–349. https://doi.org/10.1007/s00415-016-8353-3.Breckwoldt MO, Gradl J, Hähnel S, Hielscher T, Wildemann B, Diem R et al. Increasing the sensitivity of MRI for the detection of multiple sclerosis lesions by long axial coverage of the spinal cord: a prospective study in 119 patients. J Neurol. 2017;264(2):341–349. https://doi.org/10.1007/s00415-016-8353-3.Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162–173. https://doi.org/10.1016/S14744422(17)30470-2.Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162–173. https://doi.org/10.1016/S14744422(17)30470-2.Finnerup NB, Jensen TS. Spinal cord injury pain-mechanisms and treatment. Eur J Neurol. 2004;11(2):73–82. https://doi.org/10.1046/j.1351-5101.2003.00725.x.Finnerup NB, Jensen TS. Spinal cord injury pain-mechanisms and treatment. Eur J Neurol. 2004;11(2):73–82. https://doi.org/10.1046/j.1351-5101.2003.00725.x.Li X, Xu H, Zheng Z, Ouyang H, Chen G, Lou Z et al. The risk factors of neuropathic pain in neuromyelitis optica spectrum disorder: a retrospective case-cohort study. BMC Neurol. 2022;22(1):304. https://doi.org/10.1186/s12883-022-02841-9.Li X, Xu H, Zheng Z, Ouyang H, Chen G, Lou Z et al. The risk factors of neuropathic pain in neuromyelitis optica spectrum disorder: a retrospective case-cohort study. BMC Neurol. 2022;22(1):304. https://doi.org/10.1186/s12883-022-02841-9.Okuda DT, Melmed K, Matsuwaki T, Blomqvist A, Craig ADB. Central neuropathic pain in MS is due to distinct thoracic spinal cord lesions. Ann Clin Transl Neurol. 2014;1(8):554–561. https://doi.org/10.1002/acn3.85.Okuda DT, Melmed K, Matsuwaki T, Blomqvist A, Craig ADB. Central neuropathic pain in MS is due to distinct thoracic spinal cord lesions. Ann Clin Transl Neurol. 2014;1(8):554–561. https://doi.org/10.1002/acn3.85.Endo T, Spenger C, Hao J, Tominaga T, Wiesenfeld-Hallin Z, Olson L, Xu XJ. Functional MRI of the brain detects neuropathic pain in experimental spinal cord injury. Pain. 2008;138(2):292–300. https://doi.org/10.1016/j.pain.2007.12.017.Endo T, Spenger C, Hao J, Tominaga T, Wiesenfeld-Hallin Z, Olson L, Xu XJ. Functional MRI of the brain detects neuropathic pain in experimental spinal cord injury. Pain. 2008;138(2):292–300. https://doi.org/10.1016/j.pain.2007.12.017.Rivel M, Achiron A, Dolev M, Stern Y, Zeilig G, Defrin R. Central Neuropathic Pain in Multiple Sclerosis Is Associated with Impaired Innocuous Thermal Pathways and Neuronal Hyperexcitability. Pain Med. 2021;22(10):2311–2323. https://doi.org/10.1093/pm/pnab103.Rivel M, Achiron A, Dolev M, Stern Y, Zeilig G, Defrin R. Central Neuropathic Pain in Multiple Sclerosis Is Associated with Impaired Innocuous Thermal Pathways and Neuronal Hyperexcitability. Pain Med. 2021;22(10):2311–2323. https://doi.org/10.1093/pm/pnab103.Finnerup NB, Sørensen L, Biering-Sørensen F, Johannesen IL, Jensen TS. Segmental hypersensitivity and spinothalamic function in spinal cord injury pain. Exp Neurol. 2007;207(1):139–149. https://doi.org/10.1016/j.expneurol.2007.06.001.Finnerup NB, Sørensen L, Biering-Sørensen F, Johannesen IL, Jensen TS. Segmental hypersensitivity and spinothalamic function in spinal cord injury pain. Exp Neurol. 2007;207(1):139–149. https://doi.org/10.1016/j.expneurol.2007.06.001.Li J, Tian C, Yuan S, Yin Z, Wei L, Chen F et al. Neuropathic pain following spinal cord hemisection induced by the reorganization in primary somatosensory cortex and regulated by neuronal activity of lateral parabrachial nucleus. CNS Neurosci Ther. 2023;29(11):3269–3289. https://doi.org/10.1111/cns.14258.Li J, Tian C, Yuan S, Yin Z, Wei L, Chen F et al. Neuropathic pain following spinal cord hemisection induced by the reorganization in primary somatosensory cortex and regulated by neuronal activity of lateral parabrachial nucleus. CNS Neurosci Ther. 2023;29(11):3269–3289. https://doi.org/10.1111/cns.14258.

The authors declare that there are no conflicts of interest present.