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Pharmacological and Non-pharmacological Approaches for the Management of Neuropathic Pain in Multiple Sclerosis
Multiple sclerosis is a chronic inflammatory disease that affects the central nervous system and can cause various types of pain including ongoing extremity pain, Lhermitte’s phenomenon, trigeminal neuralgia, and mixed pain. Neuropathic pain is a major concern for individuals with multiple sclerosis...
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| Published in: | CNS drugs 2024-03, Vol.38 (3), p.205-224 |
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| creator | Shkodina, Anastasiia D. Bardhan, Mainak Chopra, Hitesh Anyagwa, Onyekachi Emmanuel Pinchuk, Viktoriia A. Hryn, Kateryna V. Kryvchun, Anzhelina M. Boiko, Dmytro I. Suresh, Vinay Verma, Amogh Delva, Mykhailo Yu |
| description | Multiple sclerosis is a chronic inflammatory disease that affects the central nervous system and can cause various types of pain including ongoing extremity pain, Lhermitte’s phenomenon, trigeminal neuralgia, and mixed pain. Neuropathic pain is a major concern for individuals with multiple sclerosis as it is directly linked to myelin damage in the central nervous system and the management of neuropathic pain in multiple sclerosis is challenging as the options available have limited efficacy and can cause unpleasant side effects. The literature search was conducted across two databases, PubMed, and Google Scholar. Eligible studies included clinical trials, observational studies, meta-analyses, systematic reviews, and narrative reviews. The objective of this article is to provide an overview of literature on pharmacological and non-pharmacological strategies employed in the management of neuropathic pain in multiple sclerosis. Pharmacological options include cannabinoids, muscle relaxants (tizanidine, baclofen, dantrolene), anticonvulsants (benzodiazepines, gabapentin, phenytoin, carbamazepine, lamotrigine), antidepressants (duloxetine, venlafaxine, tricyclic antidepressants), opioids (naltrexone), and botulinum toxin variants, which have evidence from various clinical trials. Non-pharmacological approaches for trigeminal neuralgia may include neurosurgical methods. Non-invasive methods, physical therapy, and psychotherapy (cognitive behavioral therapy, acceptance and commitment therapy and mindfulness-based stress reduction) may be recommended for patients with neuropathic pain in multiple sclerosis. The choice of treatment depends on the severity and type of pain as well as other factors, such as patient preferences and comorbidities. There is a pressing need for healthcare professionals and researchers to prioritize the development of better strategies for managing multiple sclerosis-induced neuropathic pain. |
| doi_str_mv | 10.1007/s40263-024-01072-5 |
| format | article |
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Neuropathic pain is a major concern for individuals with multiple sclerosis as it is directly linked to myelin damage in the central nervous system and the management of neuropathic pain in multiple sclerosis is challenging as the options available have limited efficacy and can cause unpleasant side effects. The literature search was conducted across two databases, PubMed, and Google Scholar. Eligible studies included clinical trials, observational studies, meta-analyses, systematic reviews, and narrative reviews. The objective of this article is to provide an overview of literature on pharmacological and non-pharmacological strategies employed in the management of neuropathic pain in multiple sclerosis. Pharmacological options include cannabinoids, muscle relaxants (tizanidine, baclofen, dantrolene), anticonvulsants (benzodiazepines, gabapentin, phenytoin, carbamazepine, lamotrigine), antidepressants (duloxetine, venlafaxine, tricyclic antidepressants), opioids (naltrexone), and botulinum toxin variants, which have evidence from various clinical trials. Non-pharmacological approaches for trigeminal neuralgia may include neurosurgical methods. Non-invasive methods, physical therapy, and psychotherapy (cognitive behavioral therapy, acceptance and commitment therapy and mindfulness-based stress reduction) may be recommended for patients with neuropathic pain in multiple sclerosis. The choice of treatment depends on the severity and type of pain as well as other factors, such as patient preferences and comorbidities. There is a pressing need for healthcare professionals and researchers to prioritize the development of better strategies for managing multiple sclerosis-induced neuropathic pain.</description><identifier>ISSN: 1172-7047</identifier><identifier>EISSN: 1179-1934</identifier><identifier>DOI: 10.1007/s40263-024-01072-5</identifier><identifier>PMID: 38421578</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Acceptance and Commitment Therapy ; Anticonvulsants ; Anticonvulsants - therapeutic use ; Antidepressants ; Antidepressive Agents - therapeutic use ; Baclofen ; Benzodiazepines ; Botulinum toxin ; Carbamazepine ; Central nervous system ; Clinical trials ; Cognitive ability ; Comorbidity ; Duloxetine ; Gabapentin ; Humans ; Inflammatory diseases ; Lamotrigine ; Localization ; Medicine ; Medicine & Public Health ; Multiple sclerosis ; Multiple Sclerosis - drug therapy ; Multiple Sclerosis - therapy ; Muscle relaxants ; Myelin ; Naltrexone ; Narcotics ; Nervous system ; Neuralgia ; Neuralgia - drug therapy ; Neuralgia - etiology ; Neurology ; Neurosciences ; Neurosurgery ; Observational studies ; Pain ; Patients ; Pharmacotherapy ; Phenytoin ; Physical therapy ; Psychiatry ; Psychopharmacology ; Psychotherapy ; Review Article ; Tricyclic antidepressants ; Trigeminal nerve ; Trigeminal Neuralgia - complications ; Trigeminal Neuralgia - drug therapy ; Venlafaxine</subject><ispartof>CNS drugs, 2024-03, Vol.38 (3), p.205-224</ispartof><rights>The Author(s), under exclusive licence to Springer Nature Switzerland AG 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.</rights><rights>Copyright Springer Nature B.V. 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Neuropathic pain is a major concern for individuals with multiple sclerosis as it is directly linked to myelin damage in the central nervous system and the management of neuropathic pain in multiple sclerosis is challenging as the options available have limited efficacy and can cause unpleasant side effects. The literature search was conducted across two databases, PubMed, and Google Scholar. Eligible studies included clinical trials, observational studies, meta-analyses, systematic reviews, and narrative reviews. The objective of this article is to provide an overview of literature on pharmacological and non-pharmacological strategies employed in the management of neuropathic pain in multiple sclerosis. Pharmacological options include cannabinoids, muscle relaxants (tizanidine, baclofen, dantrolene), anticonvulsants (benzodiazepines, gabapentin, phenytoin, carbamazepine, lamotrigine), antidepressants (duloxetine, venlafaxine, tricyclic antidepressants), opioids (naltrexone), and botulinum toxin variants, which have evidence from various clinical trials. Non-pharmacological approaches for trigeminal neuralgia may include neurosurgical methods. Non-invasive methods, physical therapy, and psychotherapy (cognitive behavioral therapy, acceptance and commitment therapy and mindfulness-based stress reduction) may be recommended for patients with neuropathic pain in multiple sclerosis. The choice of treatment depends on the severity and type of pain as well as other factors, such as patient preferences and comorbidities. There is a pressing need for healthcare professionals and researchers to prioritize the development of better strategies for managing multiple sclerosis-induced neuropathic pain.</description><subject>Acceptance and Commitment Therapy</subject><subject>Anticonvulsants</subject><subject>Anticonvulsants - therapeutic use</subject><subject>Antidepressants</subject><subject>Antidepressive Agents - therapeutic use</subject><subject>Baclofen</subject><subject>Benzodiazepines</subject><subject>Botulinum toxin</subject><subject>Carbamazepine</subject><subject>Central nervous system</subject><subject>Clinical trials</subject><subject>Cognitive ability</subject><subject>Comorbidity</subject><subject>Duloxetine</subject><subject>Gabapentin</subject><subject>Humans</subject><subject>Inflammatory diseases</subject><subject>Lamotrigine</subject><subject>Localization</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Multiple sclerosis</subject><subject>Multiple Sclerosis - drug therapy</subject><subject>Multiple Sclerosis - therapy</subject><subject>Muscle relaxants</subject><subject>Myelin</subject><subject>Naltrexone</subject><subject>Narcotics</subject><subject>Nervous system</subject><subject>Neuralgia</subject><subject>Neuralgia - drug therapy</subject><subject>Neuralgia - etiology</subject><subject>Neurology</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>Observational studies</subject><subject>Pain</subject><subject>Patients</subject><subject>Pharmacotherapy</subject><subject>Phenytoin</subject><subject>Physical therapy</subject><subject>Psychiatry</subject><subject>Psychopharmacology</subject><subject>Psychotherapy</subject><subject>Review Article</subject><subject>Tricyclic antidepressants</subject><subject>Trigeminal nerve</subject><subject>Trigeminal Neuralgia - complications</subject><subject>Trigeminal Neuralgia - drug therapy</subject><subject>Venlafaxine</subject><issn>1172-7047</issn><issn>1179-1934</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kUtP3TAQhS1Exav8ARaVJTbduIxfib1EiJZKQJGga2uu49wblMSpnSz672u4QCUWSJbG8nw-c-xDyAmHbxygPssKRCUZCMWAQy2Y3iEHnNeWcSvV7vNesBpUvU8Oc34EACWrao_sS6ME17U5IPFug2lAH_u47jz2FMeG3saRTe_Oz6cpRfSbkGkbE503gd7giOswhHGmsaW3YUlxwnnTeXqH3UjLuln6uZv6QO99H1LMXf5MPrXY53D8Uo_I7--XDxdX7PrXj58X59fMS1HNjBtTBQMrbVXTVGiwtm2DfIVgWu6NMhY11iuvubaaC2_AC4lQIADBuZZH5OtWt7j-s4Q8u6HLPvQ9jiEu2Qkrpao4V1DQ03foY1zSWNwVShuQVltRKLGlfHlHTqF1U-oGTH8dB_cUh9vG4Uoc7jkO9-Tiy4v0shpC83bl9f8LILdALq1xHdL_2R_I_gNzp5VP</recordid><startdate>20240301</startdate><enddate>20240301</enddate><creator>Shkodina, Anastasiia D.</creator><creator>Bardhan, Mainak</creator><creator>Chopra, Hitesh</creator><creator>Anyagwa, Onyekachi Emmanuel</creator><creator>Pinchuk, Viktoriia A.</creator><creator>Hryn, Kateryna V.</creator><creator>Kryvchun, Anzhelina M.</creator><creator>Boiko, Dmytro I.</creator><creator>Suresh, Vinay</creator><creator>Verma, Amogh</creator><creator>Delva, Mykhailo Yu</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0622-0322</orcidid><orcidid>https://orcid.org/0000-0003-2499-4874</orcidid><orcidid>https://orcid.org/0000-0002-2991-9833</orcidid><orcidid>https://orcid.org/0000-0003-0987-6503</orcidid><orcidid>https://orcid.org/0000-0001-8867-7603</orcidid><orcidid>https://orcid.org/0000-0002-1401-9154</orcidid><orcidid>https://orcid.org/0000-0002-7198-5498</orcidid><orcidid>https://orcid.org/0000-0002-4106-409X</orcidid><orcidid>https://orcid.org/0000-0001-7336-0822</orcidid><orcidid>https://orcid.org/0000-0001-5648-7506</orcidid><orcidid>https://orcid.org/0000-0002-8759-3560</orcidid></search><sort><creationdate>20240301</creationdate><title>Pharmacological and Non-pharmacological Approaches for the Management of Neuropathic Pain in Multiple Sclerosis</title><author>Shkodina, Anastasiia D. ; 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Neuropathic pain is a major concern for individuals with multiple sclerosis as it is directly linked to myelin damage in the central nervous system and the management of neuropathic pain in multiple sclerosis is challenging as the options available have limited efficacy and can cause unpleasant side effects. The literature search was conducted across two databases, PubMed, and Google Scholar. Eligible studies included clinical trials, observational studies, meta-analyses, systematic reviews, and narrative reviews. The objective of this article is to provide an overview of literature on pharmacological and non-pharmacological strategies employed in the management of neuropathic pain in multiple sclerosis. Pharmacological options include cannabinoids, muscle relaxants (tizanidine, baclofen, dantrolene), anticonvulsants (benzodiazepines, gabapentin, phenytoin, carbamazepine, lamotrigine), antidepressants (duloxetine, venlafaxine, tricyclic antidepressants), opioids (naltrexone), and botulinum toxin variants, which have evidence from various clinical trials. Non-pharmacological approaches for trigeminal neuralgia may include neurosurgical methods. Non-invasive methods, physical therapy, and psychotherapy (cognitive behavioral therapy, acceptance and commitment therapy and mindfulness-based stress reduction) may be recommended for patients with neuropathic pain in multiple sclerosis. The choice of treatment depends on the severity and type of pain as well as other factors, such as patient preferences and comorbidities. 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| subjects | Acceptance and Commitment Therapy Anticonvulsants Anticonvulsants - therapeutic use Antidepressants Antidepressive Agents - therapeutic use Baclofen Benzodiazepines Botulinum toxin Carbamazepine Central nervous system Clinical trials Cognitive ability Comorbidity Duloxetine Gabapentin Humans Inflammatory diseases Lamotrigine Localization Medicine Medicine & Public Health Multiple sclerosis Multiple Sclerosis - drug therapy Multiple Sclerosis - therapy Muscle relaxants Myelin Naltrexone Narcotics Nervous system Neuralgia Neuralgia - drug therapy Neuralgia - etiology Neurology Neurosciences Neurosurgery Observational studies Pain Patients Pharmacotherapy Phenytoin Physical therapy Psychiatry Psychopharmacology Psychotherapy Review Article Tricyclic antidepressants Trigeminal nerve Trigeminal Neuralgia - complications Trigeminal Neuralgia - drug therapy Venlafaxine |
| title | Pharmacological and Non-pharmacological Approaches for the Management of Neuropathic Pain in Multiple Sclerosis |
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