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MS – Pain Categories — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS – Pain CategoriesSCE Neurology

A 42-year-old woman with MS has chronic low back pain, bilateral leg dysaesthesiae, and Lhermitte sign. Her neurologist categorises her pain as neuropathic. What are the three main categories of pain in MS?

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Correct answer: D — Nociceptive (musculoskeletal), neuropathic (central), and mixed pain — each requires different treatment approaches

Pain in MS is classified into: (1) Neuropathic/central pain (dysaesthesiae, Lhermitte sign, trigeminal neuralgia, painful tonic spasms) — treated with neuropathic pain agents (gabapentin, pregabalin, amitriptyline, duloxetine, carbamazepine for TN). (2) Nociceptive/musculoskeletal pain (back pain from postural changes, joint pain from immobility, spasticity-related pain) — treated with physiotherapy, NSAIDs, muscle relaxants. (3) Mixed pain (combination). NICE NG100 recommends systematic pain assessment and treatment. A: Multiple pain types exist. C: Pain affects ~60–80% of MS patients. D: Headache is just one type. E: Multiple categories exist.

Reference: NICE NG100 MS (2022); ABN MS Pain Guidelines