CENTRAL PAIN IN LONGITUDINALLY EXTENSIVE TRANSVERSE MYELITIS WITH NO BRAIN LESIONS: CLINICAL CHARACTERIZATION OF PAIN SYNDROMES.

Introduction: Pain in inflammatory myelopathies is frequent but has not been clinically characterized. It is an appropriate model to assess pain mechanisms after spinal cord inflammatory lesions since there are no brain lesions that could bias pain assessment, cognition and mood assessment. It has been suggested that the prevalence and severity of pain syndromes among patients with neuromyelitis optica (NMO) and longitudinally extensive transverse myelitis (LETM) are greater in comparison to those with multiple sclerosis. It is not clear whether higher scores on the Expanded Disability Status Scale (EDSS) could influence pain and health-related quality of life scores. This study aimed to characterize disability, pain syndromes, and quality of life in this population. Materials and Methods: Patients with spinal cord-restricted demyelinating disease (last relapse at least 12 months prior to evaluation) and complaint of pain underwent a full physical examination and filled out a DN-4 questionnaire, Brief Pain Inventory (BPI), Neuropathic Pain Symptom Inventory (NPSI), McGill Pain Questionnaire (MPQ) and SF-12 Health Survey. Disability was assessed using the EDSS. Spasticity was measured using the Ashworth Scale. Patients were classified as at-level and below-level pain. Results: Twenty patients were included (15 female, 45.3±9.8 yr).Twelve (60%) were diagnosed as NMO, the remaining as LETM. At-level pain was present in 9 (45%) and below-level in 10 (50%). Thirteen (65%) patients had more than one pain syndrome. Results refer to the main pain syndrome. The median scores of the BPI (VAS) was 21.9±7.2; BPI interference 24.9±15.3; Mental Component Summary Scale of the SF12 49.5 ± 10.7; Physical Component Summary 33.0±10.3; NPSI 23.3±15.4; and MPQ 8.5±2.5. The median EDSS was 4.8±2.4 and Ashworth spasticity scale 1.35±1.1. The DN4 detected neuropathic pain (NeP) in 18 patients. Low back pain was a major pain complaint in 6 (30%) patients. Discussion and Conclusion: NeP is frequent in patients with inflammatory myelopathies. Low back pain was noted as the main pain syndrome in a significant proportion of patients. Mixed pain syndromes are the rule in these patients. [ABSTRACT FROM AUTHOR]