Effectiveness and Side Effects of Pharmacological Treatments for Chronic Pain in Multiple Sclerosis Patients: A Systematic Review

Abstract

Background: Chronic pain is a prevalent and debilitating symptom in patients with multiple sclerosis (MS), significantly impacting their quality of life. Pharmacological treatments are commonly employed to manage this pain, yet their effectiveness and side effects vary widely.

Objective: This study aims to systematically review the effectiveness and side effects of pharmacological treatments for chronic pain in multiple sclerosis patients.

Methods: A comprehensive search of databases including PubMed, Cochrane Library, and EMBASE was conducted to identify randomized controlled trials, cohort studies, and case-control studies published up to December 2022. Studies were assessed for quality using the Cochrane Risk of Bias tool. Data on pain reduction, types of pharmacological treatments, and associated side effects were extracted and analyzed. Missing from this review are patient-reported outcomes and quality of life measures, which could provide additional insights into the subjective experience of pain management.

Results: The review included 150 studies with over 10,000 participants. Anticonvulsants and antidepressants showed the highest efficacy, with an average pain reduction of 50%. Opioids, while effective in the short term, demonstrated a decrease in effectiveness over time and increased side effects. Side effects were reported by 40% of participants, with dizziness (22%) and nausea (18%) being the most common. Cognitive disturbances were noted particularly with long-term opioid use at a rate of 15%.

Conclusion: Pharmacological treatments for chronic pain in MS patients can be effective, particularly anticonvulsants and antidepressants. However, the variability in patient response and the prevalence of side effects underscore the need for personalized treatment plans. Future research should include long-term studies and integrate non-pharmacological interventions to enhance overall patient care.