Unique features of central neuropathic pain in multiple sclerosis: Results of a cluster analysis

Michal Rivel, Anat Achiron, Mark Dolev, Yael Stern, Gabi Zeilig, Ruth Defrin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Central neuropathic pain (CNP) is an excruciating condition, prevalent in up to a third of patients with multiple sclerosis (MS). Identifying CNP among MS patients is particularly challenging considering the ample comorbid chronic pain conditions and sensory disturbances entailed by the disease. The aim was to identify sensory features unique to CNP beyond those of chronic pain and MS. Methods: Participants were 112 MS patients: 44 with a diagnosis of CNP, 28 with a diagnosis of chronic musculoskeletal pain (MSP), and 40 pain free. Participants underwent testing of thermal and mechanical thresholds, thermal grill illusion (TGI), pain adaptation (PA), and offset analgesia (OA), and chronic pain was characterized. A two-step cluster analysis was performed, and the association between the cluster membership and the clinical group membership (CNP, MSP, pain free) was evaluated. Results: The CNP and MSP groups were similar in most of the chronic pain variables (e.g., severity, location and quality) and MS-related variables (e.g., type, severity and medication intake). The three created clusters had unique sensory features: (1) ‘Hyposensitivity’ (increased thermal and touch thresholds) characterized the CNP group; (2) ‘Poor inhibition and hyperalgesia’ (worst PA and OA and decreased TGI threshold) characterized the MSP group; and (3) ‘Efficient inhibition’ (best PA and OA, smallest sensory loss) characterized the pain-free group. Conclusions: The unique sensory features of CNP and MSP provide insight into their pathophysiology, and evaluating them may increase the ability to provide individually based interventions. Efficient inhibition may protect MS patients from chronic pain. Significance: Cluster analysis among patients with multiple sclerosis (MS) revealed that while central neuropathic pain is associated with thermal and mechanical hypoesthesia, musculoskeletal pain is involved with reduced pain inhibition and hyperalgesia; sensory profiles that provide insights into the mechanisms of these conditions and may promote an individually based pain management.

Original languageEnglish
Pages (from-to)1107-1122
Number of pages16
JournalEuropean Journal of Pain
Issue number5
StatePublished - May 2022


Dive into the research topics of 'Unique features of central neuropathic pain in multiple sclerosis: Results of a cluster analysis'. Together they form a unique fingerprint.

Cite this