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Chronic neuropathic pain severity is determined by lesion level in aquaporin 4-antibody-positive myelitis
- Source :
- Journal of neurology, neurosurgery, and psychiatry. 88(2)
- Publication Year :
- 2016
-
Abstract
- IMPORTANCE: Chronic, intractable neuropathic pain is a common and debilitating consequence of neuromyelitis optica spectrum disorder (NMOSD) myelitis, with no satisfactory treatment; few studies have yet to explore its aetiology. OBJECTIVE: To establish if myelitis-associated chronic pain in NMOSD is related to the craniocaudal location of spinal cord lesions. METHOD: (1) Retrospective cohort of 76 aquaporin 4-antibody (AQP4-Ab)-positive patients from Oxford and Liverpool's national NMOSD clinics, assessing current pain and craniocaudal location of cord lesion contemporary to pain onset. (2) Focused prospective study of 26 AQP4-Ab-positive Oxford patients, a subset of the retrospective cohort, assessing current craniocaudal lesion location and current pain. RESULTS: Patients with isolated thoracic cord myelitis at the time of pain onset were significantly more disabled and suffered more pain. Cervical and thoracic lesions that persisted from pain onset to 'out of relapse' follow-up (current MRI) had highly significant (p CONCLUSIONS: Persistent, caudally located (ie, thoracic) cord lesions in AQP4-Ab-positive patients associate with high postmyelitis chronic pain scores, irrespective of number of myelitis relapses, lesion length and lesion burden. Although disability correlated with pain in isolation, it became an insignificant predictor of pain when analysed alongside craniocaudal location of lesions.
- Subjects :
- 0301 basic medicine
Adult
Male
medicine.medical_specialty
Myelitis
Severity of Illness Index
Lesion
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
Prospective cohort study
Aged
Autoantibodies
Pain Measurement
Retrospective Studies
Aquaporin 4
Neuromyelitis optica
Referred pain
business.industry
Neuromyelitis Optica
Chronic pain
Retrospective cohort study
Middle Aged
medicine.disease
Magnetic Resonance Imaging
Surgery
Psychiatry and Mental health
030104 developmental biology
Spinal Cord
Neuropathic pain
Neuralgia
Female
Neurology (clinical)
medicine.symptom
Chronic Pain
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 1468330X
- Volume :
- 88
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Journal of neurology, neurosurgery, and psychiatry
- Accession number :
- edsair.doi.dedup.....6d657ca39b8a9fdd9f9fbbfdd8393804