Pain in Multiple Sclerosis and the Muscular Dystrophies
Frederick M. Perkins Richard T. Moxley III Anthony S. Papciak University of Rochester, School of Medicine and Dentistry
Individuals with any disease may experience pain from the usual nociceptive stimuli, but some disorders predispose patients to particular pain problems. In this chapter we review the causes for the pains that occur commonly in patients with multiple sclerosis and the muscular dystrophies. In the closing portion of the chapter we discuss the medical and psychological management of these typical pain problems.
Multiple sclerosis (MS), a demyelinating disease of the central nervous system (CNS), is "the great crippler of young adults," having its onset between the second to fifth decades. MS varies in its geographic distribution, being rare in tropical and subtropical zones and having a disease rate that increases with increasing latitude in both the Northern Hemisphere and the Southern Hemisphere ( Hogancamp, Rodriguez, & Weinshenker, 1997). The occurrence of MS varies considerably among ethnic groups. There is a low incidence in Native Americans, Asians, and Africans, and a high incidence in Whites ( Hogancamp et al., 1997; Poser, 1994), especially those having certain HLA (human leukocyte antigen) genotypes ( Ebers & Sadovnick, 1994). For example, there are no reported cases of MS in full-blooded American Indians in British Columbia, Canada, whereas there is an incidence of 2/1000 in certain populations in Scotland ( Sadovnick & Ebers, 1993).