Characterizing chronic pain phenotypes in multiple sclerosis: a nationwide survey study

Chronic pain is highly prevalent in multiple sclerosis (MS). Pain heterogeneity may contribute to poor treatment outcomes. The aim of this study was to characterize pain phenotypes distributions in persons with multiple sclerosis (MS), and compare pain phenotypes in terms of pain intensity, frequency of chronic overlapping pain conditions, and use and analgesic effects of different classes of pain medications. Data were collected via a national web-based survey with measures of neuropathic (painDETECT) and nociplastic pain (Fibromyalgia survey criteria), chronic overlapping pain conditions, and pain medication use and pain relief. In a sample of N=842 adults with chronic pain and MS, the largest proportion (41%) showed evidence of nociceptive pain, 27% had mixed neuropathic/nociplastic pain, 23% had nociplastic pain, and 9% had neuropathic pain. Nociplastic pain was associated with significantly higher pain intensity and frequency of chronic overlapping pain conditions. Across all pain types, high frequency of pain medication use along with poor-modest pain relief were reported. Cannabis use for pain was more common and pain relief ratings were higher among those with nociplastic pain, relative to nociceptive pain. Although NSAIDs use was highest among those with nociplastic pain (80%), pain relief ratings for NSAIDs were highest among those with nociceptive pain. These findings underscore the need for multidimensional assessment of pain in MS with greater emphasis on the identification of pain phenotype. An improved characterization of pain as a multifaceted condition in MS could inform therapeutic approaches.