Pain as heralding symptom in multiple sclerosis

It is becoming recognised that neuropathic pain is among the major burdens of patients affected by multiple sclerosis (MS). Neuropathic pain may be an early symptom of the disease. Well known presentations are symptomatic trigeminal neuralgia and also pseudo-radicular pain due to lesions of the dorsal entry zone. Here we report two patients with visceral pain and three patients with pseudo-radicular pain due to spinothalamic lesion (central pain) caused by MS. The diagnosis was hampered and delayed by the absence of objective signs. In four patients the only abnormal clinical finding was spinothalamic hypoaesthesia. Pain may be one of the heralding symptoms of MS. In the present series it was severe, chronic and poorly responsive to treatment. A sensory examination is mandatory in all cases of complex pain syndromes of unidentified nature.