Research into pain in multiple sclerosis

3 July 2014

Dr Peter Foley, a Rowling Scholar undertaking his PhD, is studying pain in multiple sclerosis (MS).

Pain has not always been a major focus of research or clinical care in MS, and it can be an “invisible” symptom for people who have it – difficult for others to understand, and sometimes impossible to describe. There is however strong evidence that pain in MS is linked to many negative experiences for patients. These can include poorer physical health, poorer mental health and employment problems.

Despite the importance of pain in MS, treatment choices for patients are limited, and often do not work well. In part, this may relate to our poor understanding of pain.

What determines why some people have only mild pain, and others much more severe? And could a better understanding of this problem help to develop treatments to reduce pain intensity?

For his PhD studies, Dr Peter Foley firstly aimed to identify how common pain in MS actually is, and to assess which groups of patients may be more likely to suffer from it than others. To do this, Peter identified and assessed existing studies of people with MS and pain worldwide.

Peter’s analysis of existing pain studies found that pain affects the majority of people with MS - around 3 in 5 of all people with the condition – but that within this large number there are many different types of pain. This work was published in 2013* and has led to interest from UK MS charities, as well as others.

Peter is now focussing on people with MS who have nerve pain (neuropathic pain) – a particular type of pain related to MS. He is carrying out detailed medical and psychological testing, along with magnetic resonance imaging (MRI) scanning, on patients, to examine why some have more or less severe pain. In particular, he is interested in whether pain intensity may be linked to damaged pain processing pathways in the brain. His work uses state of the art functional MRI (“fMRI”) scanning to better understand how the brain processes pain. He is collaborating with several different groups at the Universities of Edinburgh and Oxford, including scanning, psychology, MS and pain specialists.

Recruitment for this study is going well, with just under half of the target number of patients having already kindly contributed to the study. More patients continue to be referred to the study through their MS or pain specialist teams.

Analysis of scans and other information is in the early stages, however it has suggested some interesting patterns. Some initial work on functional MRI scans from the study will be presented at the British Chapter of the “ISMRM” MRI research group in Edinburgh in September 2014.

Peter hopes that, in the future, knowledge of how pain develops, and how pain is processed by the brains of people with MS, may lead to a better understanding of the importance of pain in this condition, and eventually to the development of better treatments.

 

* Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis. Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT. Pain. 2013 May;154(5):632-42. doi: 10.1016/j.pain.2012.12.002. Epub 2012 Dec 14. Review.

Also see coverage of this paper as a recommended article on F1000Prime.

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