Domenico Plantone1, Catello Vollono2, Matteo Pardini3, Guido Primiano2, Virxhina Myftari4, Francesca Vitetta5, Patrizia Sola5, Massimiliano Mirabella2, Diana Ferraro4,5. 1. Neurology Unit, Di Venere Hospital-ASL Bari, Via Ospedale Di Venere, 1, 70131, Bari, Italy. domenicoplantone@hotmail.com. 2. Neurology Institute, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy. 3. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy. 4. Department of Biomedical Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy. 5. Neurology Unit, Ospedale Civile, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
Abstract
BACKGROUND: Pain is one of the most disabling symptoms in multiple sclerosis. Chronic pain in multiple sclerosis is often neuropathic in nature, although a clear-cut distinction with nociceptive pain is not easy. OBJECTIVE: The aim of our study was to analyze the MRIs of multiple sclerosis patients with chronic pain in order to explore possible associations with lesion sites, on a voxel-by-voxel basis. MATERIALS AND METHODS: We enrolled patients aged > 18 years with multiple sclerosis in accordance with the 2010 McDonald criteria. Patients meeting criteria for persistent pain (frequent or constant pain lasting > 3 months) were included in the "pain group". The other patients were included in the "no pain group". We outlined lesions on FLAIR MRI scans using a semi-automated edge finding tool. To detect the association between lesion localization and persistent pain, images were analysed with the voxel-based lesion symptom mapping methods implemented in the (nonparametric mapping software included into the MRIcron. RESULTS: We enrolled 208 MS patients (140 F, mean age 55.2 ± 9.4 years; 176 RR, 28 progressive MS; mean EDSS 2.0 + 2.0). Pain group included 96 patients and no pain group 112 patients. Lesions of the right dorsolateral prefrontal area were significantly more prevalent in patients without pain, whereas periventricular posterior lesions were significantly more prevalent in patients with persistent pain. CONCLUSION: Our data suggest a role of the right dorsolateral prefrontal cortex in the modulation of pain perception and in the occurrence of chronic pain in MS patients. Our data also support a hemispheric asymmetry in pain perception and modulation.
BACKGROUND:Pain is one of the most disabling symptoms in multiple sclerosis. Chronic pain in multiple sclerosis is often neuropathic in nature, although a clear-cut distinction with nociceptive pain is not easy. OBJECTIVE: The aim of our study was to analyze the MRIs of multiple sclerosispatients with chronic pain in order to explore possible associations with lesion sites, on a voxel-by-voxel basis. MATERIALS AND METHODS: We enrolled patients aged > 18 years with multiple sclerosis in accordance with the 2010 McDonald criteria. Patients meeting criteria for persistent pain (frequent or constant pain lasting > 3 months) were included in the "pain group". The other patients were included in the "no pain group". We outlined lesions on FLAIR MRI scans using a semi-automated edge finding tool. To detect the association between lesion localization and persistent pain, images were analysed with the voxel-based lesion symptom mapping methods implemented in the (nonparametric mapping software included into the MRIcron. RESULTS: We enrolled 208 MS patients (140 F, mean age 55.2 ± 9.4 years; 176 RR, 28 progressive MS; mean EDSS 2.0 + 2.0). Pain group included 96 patients and no pain group 112 patients. Lesions of the right dorsolateral prefrontal area were significantly more prevalent in patients without pain, whereas periventricular posterior lesions were significantly more prevalent in patients with persistent pain. CONCLUSION: Our data suggest a role of the right dorsolateral prefrontal cortex in the modulation of pain perception and in the occurrence of chronic pain in MS patients. Our data also support a hemispheric asymmetry in pain perception and modulation.
Authors: Reinhold Schmidt; Michael Bach; Peter Dal-Bianco; Peter Holzer; Aga Pluta-Fuerst; Eva Assem-Hilger; Anita Lechner; Margherita Cavalieri; Bernhard Haider; Helena Schmidt; Georg Pinter; Wolfgang Pipam; Elisabeth Stögmann; Christian Lampl; Rudolf Likar Journal: Neuropsychiatr Date: 2010
Authors: Augusto Caraceni; Tito R Mendoza; Emanuela Mencaglia; Claudio Baratella; Katherine Edwards; Maria Joao Forjaz; Cinzia Martini; Ronald C Serlin; Franco de Conno; Charles S Cleeland Journal: Pain Date: 1996-04 Impact factor: 6.961