Clinical and radiological characteristics of central pain in demyelinating diseases with spinal cord lesions

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

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. 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. 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.

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